NPIMap

Individual provider Active NPI

Scott C. Gibson, M.D.

  • Emergency Medical Services (Emergency Medicine) Physician
  • Kalamazoo, MI
National Provider Identifier
1073554325
Registry record updated Mar 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
4301063448 Issued in MI
Practice address
125 S Kalamazoo Mall
Suite 204
Kalamazoo, MI 49007-4832
Phone
(269) 343-3900
Fax
(269) 343-5640
NPI assigned
Jun 9, 2006
Last updated
Mar 24, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 4301063448 MI Primary

Addresses

Primary practice location

125 S Kalamazoo Mall
Suite 204
Kalamazoo, MI 49007-4832

Mailing address

125 S Kalamazoo Mall
Suite 204
Kalamazoo, MI 49007-4832
Phone (269) 343-3900

Other identifiers 2

IdentifierTypeStateIssuer
10/4686884MedicaidMI
10/3068510MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050115000087 MI Practitioner - Emergency MedicinePractitioner - General Practice 7214822980 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
93.26 of 100Reported as group
Quality
79.63
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301063448MIMDEmergency Medical Services (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southwestern Michigan Emergency Services, PC Emergency Medical Services CurrentSince Apr 17, 2019 Accepting new patients
Bronson Methodist Hospital CurrentSince Dec 1, 2015 Accepting new patients
Bronson Methodist Hospital CurrentSince Jul 1, 2024 Accepting new patients

Locations

8116 Reliable Pkwy
Chicago, IL 60686

555 Linn St
Allegan, MI 49010
Phone (269) 673-8424

125 S Kalamazoo Mall
Ste 204
Kalamazoo, MI 49007
Phone (269) 343-3900

601 John St
Kalamazoo, MI 49007
Phone (269) 341-7100

601 John St
Ste M-124
Kalamazoo, MI 49007
Phone (269) 341-7500

6220 W Main St
Kalamazoo, MI 49009
Phone (269) 276-4744

940 John St
Kalamazoo, MI 49001
Phone (269) 343-7296

200 N Madison St
Marshall, MI 49068
Phone (269) 789-3921

408 Hazen St
Paw Paw, MI 49079
Phone (269) 341-8481

5121 S Westnedge Ave
Portage, MI 49002
Phone (269) 337-2110

Ownership & related parties

All facility ownership & control disclosures 13

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Bronson Methodist HospitalKalamazoo, MI, CCN 230017 Hospital Corporate Director Jun 1, 2008
Bronson Battle Creek HospitalBattle Creek, MI, CCN 230075 Hospital Corporate Director Jul 1, 2011
Bronson Lakeview HospitalPaw Paw, MI, CCN 231332 Hospital Corporate Director Jun 1, 2008
Bronson South Haven HospitalSouth Haven, MI, CCN 230085 Hospital Corporate Director Jan 1, 2017
Bronson South Haven HospitalSouth Haven, MI, CCN 23U085 Hospital Corporate Director Jan 1, 2017
Bronson Lakeview HospitalPaw Paw, MI, CCN 23Z332 Hospital Corporate Director Jun 1, 2008
Bronson CommonsMattawan, MI, CCN 235434 Skilled nursing facility Corporate Director Sep 28, 2012
Bronson at Home Healthcare ServicesBattle Creek, MI, CCN 237028 Home health agency Corporate Officer (100%) Oct 1, 2014
Bronson Lakeview Family Care-Paw PawPaw Paw, MI, CCN 238601 Rural health clinic Corporate Director Jun 1, 2008
Bronson Lakeview Family Care-DecaturDecatur, MI, CCN 238546 Rural health clinic Corporate Director Jun 1, 2008
Bronson South Haven Hospital RHCSouth Haven, MI, CCN 233987 Rural health clinic Corporate Director Jan 1, 2006
Bronson Lakeview Family Care - BangorBangor, MI, CCN 238533 Rural health clinic Corporate Director Jan 1, 2006
Bronson Lakeview Family Care - Blue StarSouth Haven, MI, CCN 238770 Rural health clinic Corporate Director Jan 1, 2006

Owned or controlled facilities with NPI records 11

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269388800000",
    "number": "1073554325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 S KALAMAZOO MALL",
            "address_2": "SUITE 204",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490074832",
            "telephone_number": "269-343-3900",
            "fax_number": "269-343-5640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 S KALAMAZOO MALL",
            "address_2": "SUITE 204",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490074832",
            "telephone_number": "269-343-3900",
            "fax_number": "269-343-5640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "SCOTT",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2010-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "MI",
            "license": "4301063448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10/4686884",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10/3068510",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.