NPIMap

Individual provider Active NPI

Maureen Reynolds Street, MD

  • Family Medicine Physician
  • Elk Rapids, MI
National Provider Identifier
1093716052
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301064260 Issued in MI
Practice address
9060 N Bayshore Dr Ste 2
Elk Rapids, MI 49629-9435
Phone
(231) 498-4552
Fax
(866) 920-0420
NPI assigned
Aug 2, 2005
Last updated
Aug 2, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036126839 IL
Family Medicine Physician 207Q00000X 4301064260 MI Primary

Addresses

Primary practice location

9060 N Bayshore Dr Ste 2
Elk Rapids, MI 49629-9435

Mailing address

9060 N Bayshore Dr Ste 2
Elk Rapids, MI 49629-9435
Phone (231) 498-4552

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
I20041207000122 MI Practitioner - Family Practice 1557327038 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Human Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
East Jordan Family Health CenterGroup PAC ID 8325932510, shared by 2 NPIs, 8 clinicians

Practice addresses (Care Compare)

4955 S M 88 Hwy
Bellaire, MI 49615-9082
Phone (231) 533-8649

601 Bridge St
East Jordan, MI 49727-9383

601 Bridge St
East Jordan, MI 49727-9421
Phone 2315362206168

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
East Jordan Family Health Center CurrentSince Feb 1, 2023 Accepting new patients
East Jordan Family Health Center CurrentSince Feb 1, 2023 Accepting new patients
Advantage Health Physicians PC Family Medicine Past Accepting new patients

Locations

4955 S M 88 Hwy
Bellaire, MI 49615
Phone (231) 533-8649

601 Bridge St
East Jordan, MI 49727
Phone (231) 536-2206

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: maureen.street.p1@direct.ejfhc.nextgenshare.com

Organizations & group practices 4

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1093716052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9060 N BAYSHORE DR STE 2",
            "city": "ELK RAPIDS",
            "state": "MI",
            "postal_code": "496299435",
            "telephone_number": "231-498-4552",
            "fax_number": "866-920-0420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9060 N BAYSHORE DR STE 2",
            "city": "ELK RAPIDS",
            "state": "MI",
            "postal_code": "496299435",
            "telephone_number": "231-498-4552",
            "fax_number": "866-920-0420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STREET",
        "first_name": "MAUREEN",
        "middle_name": "REYNOLDS",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-02",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036126839",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301064260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk Rapids, MI

Sources for this page

Verify at the official NPI Registry.