NPIMap

Organization Active NPI

Ascension Medical Group Promed

  • Pediatrics Physician
  • Sturgis, MI
National Provider Identifier
1013926997
Registry record updated Dec 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
ASCENSION MEDICAL GROUP PROMED
Practice address
1555 E Chicago Rd
Sturgis, MI 49091-1993
Phone
(269) 651-7114
NPI assigned
Aug 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2022

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

Authorized official

Name
Marin Houghton
Title
Cfo
Phone
(269) 226-4800

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VG0400X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

1555 E Chicago Rd
Sturgis, MI 49091-1993

Mailing address

1717 Shaffer St Ste 2
Kalamazoo, MI 49048-1623
Phone (269) 552-2836

Other identifiers 1

IdentifierTypeStateIssuer
350C910110OtherBCBSM

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031216000478 MI Part B Supplier - Clinic/Group Practice 7315856077 Receives reassigned benefits from 562 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 42

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

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672358400000",
    "number": "1013926997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 SHAFFER ST STE 2",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490481623",
            "telephone_number": "269-552-2836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 E CHICAGO RD",
            "city": "STURGIS",
            "state": "MI",
            "postal_code": "490911993",
            "telephone_number": "269-651-7114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASCENSION MEDICAL GROUP PROMED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-07",
        "last_updated": "2022-12-30",
        "certification_date": "2022-12-30",
        "status": "A",
        "authorized_official_last_name": "HOUGHTON",
        "authorized_official_first_name": "MARIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "269-226-4800"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "350C910110",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sturgis, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2022; 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.