Clarissa Kroese, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5315021617 Issued in MI

Practice address

1460 N Center Rd
Burton, MI 48509-1429

Phone

(810) 715-4300

NPI assigned

Mar 28, 2007

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Livwell Physicians

  • Family Medicine Physician
  • Brighton, MI
  • NPI 1881585529
  Medicare reassignment NPD
• McLaren Flint

  • General Practice Physician
  • Flint, MI
  • NPI 1275807372

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1033238258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1460 N CENTER RD",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485091429",
            "telephone_number": "810-715-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 N CENTER RD",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485091429",
            "telephone_number": "810-715-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KROESE",
        "first_name": "CLARISSA",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-28",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5315021617",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4768086",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Marie King
• Tamara Denise Knuckles
• Whitney Rayne Kononchuk
• Audrey Lynn Koresh, MA, BCBA
• Christopher Kowalski, O.D.
• Kroger Co of Michigan (Kroger Pharmacy)
• Richard Labaere II, D.O.
• Gerald L Larson, DO
• Kimberly Lasle
• Carlos Lasmarias, MD

• Family Medicine Physician in Burton, MI
• Providers in Burton, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.