Individual provider Active NPI

Joseph Edward Podd, PA-C

  • Surgical Physician Assistant
  • Ypsilanti, MI
National Provider Identifier
1083677371
Registry record updated Jan 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
5601001374 Issued in MI
Practice address
5301 E Huron River Dr
Ypsilanti, MI 48197-1051
Phone
(734) 712-5609
Fax
(734) 712-5797
NPI assigned
Apr 9, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 23, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 5601001374 MI Primary

Addresses

Primary practice location

5301 E Huron River Dr
Ypsilanti, MI 48197-1051

Mailing address

5301 E Huron River Dr
Ypsilanti, MI 48197-1051
Phone (734) 712-5609

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050622000201 MI Practitioner - Physician Assistant 5193760015

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1982
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

5301 E Huron River Dr MC
Suite 69504
Ypsilanti, MI 48197-1051

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Joseph Mercy Hospital Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1144540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390435200000",
    "number": "1083677371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5301 E HURON RIVER DR",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971051",
            "telephone_number": "734-712-5609",
            "fax_number": "734-712-5797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 E HURON RIVER DR",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971051",
            "telephone_number": "734-712-5609",
            "fax_number": "734-712-5797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PODD",
        "first_name": "JOSEPH",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-09",
        "last_updated": "2014-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MI",
            "license": "5601001374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ypsilanti, MI

Sources for this page

Verify at the official NPI Registry.