Organization Active NPI

Michigan Advanced Neurology Center, PLLC

  • Neurology Physician
  • Saginaw, MI
National Provider Identifier
1003004086
Registry record updated Sep 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
DM066728 Issued in MI
Legal business name
MICHIGAN ADVANCED NEUROLOGY CENTER, PLLC
Practice address
4705 Towne Ctr
Ste. 201
Saginaw, MI 48604-2818
Phone
(989) 799-2770
Fax
(989) 799-2737
NPI assigned
Oct 4, 2007
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Ms. Lisa Macarthur
Title
Office Manager
Phone
(989) 799-2770

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050111000462 MI Part B Supplier - Clinic/Group Practice 3072561505 Receives reassigned benefits from 1 practitioner
Practice locations: Saginaw, MI

National Provider Directory

National Provider Directory

Locations

4705 Towne Centre Rd
Ste 201
Saginaw, MI 48604
Phone (989) 497-3091

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X DM066728 MI Primary

Addresses

NPPES NPI Registry

Primary practice location

4705 Towne Ctr
Ste. 201
Saginaw, MI 48604-2818

Mailing address

4705 Towne Ctr
Ste. 201
Saginaw, MI 48604-2818
Phone (989) 799-2770

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
4695041MedicaidMI

Other names 1

NPPES NPI Registry
  • MANC Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 25, 2020.

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600992000000",
    "number": "1003004086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4705 TOWNE CTR",
            "address_2": "STE. 201",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486042818",
            "telephone_number": "989-799-2770",
            "fax_number": "989-799-2737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4705 TOWNE CTR",
            "address_2": "STE. 201",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486042818",
            "telephone_number": "989-799-2770",
            "fax_number": "989-799-2737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN ADVANCED NEUROLOGY CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-04",
        "last_updated": "2020-09-25",
        "certification_date": "2020-09-25",
        "status": "A",
        "authorized_official_last_name": "MACARTHUR",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "989-799-2770",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "DM066728",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4695041",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MANC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saginaw, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.