Organization Active NPI

Advanced Asthma Allergy & Immunology Care PC

  • Allergy Physician
  • Ypsilanti, MI
National Provider Identifier
1053577536
Registry record updated Aug 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy PhysicianTaxonomy code 207KA0200X
License
CC788218 Issued in MI
Legal business name
ADVANCED ASTHMA ALLERGY & IMMUNOLOGY CARE PC
Practice address
4870 W Clark Rd
Suite 202
Ypsilanti, MI 48197-1104
Phone
(734) 434-5430
Fax
(734) 434-5762
NPI assigned
Aug 4, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2008

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

Authorized official

Name
Ms. Lisa Stringham
Title
Credentialing Manager
Phone
(269) 969-8920

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207KA0200X CC788218 MI Primary

Addresses

Primary practice location

4870 W Clark Rd
Suite 202
Ypsilanti, MI 48197-1104

Mailing address

49 S Cass St
Battle Creek, MI 49037-2331
Phone (269) 969-8920

Other identifiers 1

IdentifierTypeStateIssuer
104929015MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081120000748 MI Part B Supplier - Clinic/Group Practice 4082774096 Receives reassigned benefits from 1 practitioner
Practice locations: Ypsilanti, MI

National Provider Directory

National Provider Directory

Locations

49 Cass St S
Battle Creek, MI 49037

2140 Washtenaw Rd
Ypsilanti, MI 48197
Phone (734) 434-5430

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": "1217808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217808000000",
    "number": "1053577536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 S CASS ST",
            "city": "BATTLE CREEK",
            "state": "MI",
            "postal_code": "490372331",
            "telephone_number": "269-969-8920",
            "fax_number": "269-969-8921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4870 W CLARK RD",
            "address_2": "SUITE 202",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971104",
            "telephone_number": "734-434-5430",
            "fax_number": "734-434-5762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED ASTHMA ALLERGY & IMMUNOLOGY CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-04",
        "last_updated": "2008-08-04",
        "status": "A",
        "authorized_official_last_name": "STRINGHAM",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "269-969-8920",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Allergy & Immunology, Allergy",
            "state": "MI",
            "license": "CC788218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104929015",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ypsilanti, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2008; 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.