NPIMap

Organization Active NPI

George E. Drake, M.D., P.C.

  • Primary Care Clinic/Center
  • Niles, MI
National Provider Identifier
1013114552
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
4301034140 Issued in MI
Legal business name
GEORGE E. DRAKE, M.D., P.C.
Practice address
1 S 5TH St
Niles, MI 49120-2710
Phone
(269) 687-9607
NPI assigned
Jun 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. George Erving Drake, M.D.NPI 1073559415
Title
President Owner
Phone
(269) 687-9607

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 4301034140 MI Primary

Addresses

Primary practice location

1 S 5TH St
Niles, MI 49120-2710

Mailing address

732 S 11TH St
Suite 100 #242
Niles, MI 49120-3368
Phone (269) 687-9607

Other identifiers 3

IdentifierTypeStateIssuer
P00218423OtherMIRR MEDICARE
4731175MedicaidMI
0801110581OtherMIBCBS

National Provider Directory

National Provider Directory

Locations

732 S 11th St
Ste 100
Niles, MI 49120

1 S 5th St
Niles, MI 49120
Phone (269) 687-9607

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013114552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "732 S 11TH ST",
            "address_2": "SUITE 100 #242",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491203368",
            "telephone_number": "269-687-9607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 S 5TH ST",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491202710",
            "telephone_number": "269-687-9607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGE E. DRAKE, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DRAKE",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "ERVING",
        "authorized_official_title_or_position": "PRESIDENT  OWNER",
        "authorized_official_telephone_number": "269-687-9607",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MI",
            "license": "4301034140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00218423",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4731175",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0801110581",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Niles, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.