Active NPI
Edmond J. Ducommun, M.D.
- Physical Medicine & Rehabilitation Physician
- Lansing, MI
National Provider Identifier
1093767816
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 4301059003
- Practice address
- 1540 Lake Lansing Rd
Ste 101
Lansing, MI 48912-3707 - Phone
- (517) 913-3810
- Fax
- (517) 913-3811
- NPI assigned
- May 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 4301059003 | MI | Primary |
Addresses
Primary practice location
1540 Lake Lansing Rd
Ste 101
Lansing, MI 48912-3707
Mailing address
1540 Lake Lansing Rd
Ste 101
Lansing, MI 48912-3707
Phone (517) 913-3810
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200000001909 | Other | MI | PHP |
| 1010729 | Other | MI | MCLAREN HEALTH PLAN-MEDICAID |
| 4594007 | Other | MI | AETNA |
| P00464732 | Other | MI | RAILROAD MEDICARE |
| 200000001909 | Other | MI | PHP FAMILYCARE |
| 0250331789 | Other | MI | BLUE CROSS BLUE SHIELD OF MICHIGAN |
| 1010729 | Other | MI | MCLAREN HEALTH PLAN-COMMERCIAL |
| 4541831 | Medicaid | MI | |
| 0M214400029 | Other | MI | MEDICARE PLUS BLUE |
| 1010729 | Other | MI | MCLAREN HEALTH ADVANTAGE |
| 4848089 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301059003 | MI | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1567468800000",
"number": "1093767816",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1540 LAKE LANSING RD",
"address_2": "STE 101",
"city": "LANSING",
"state": "MI",
"postal_code": "489123707",
"telephone_number": "517-913-3810",
"fax_number": "517-913-3811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1540 LAKE LANSING RD",
"address_2": "STE 101",
"city": "LANSING",
"state": "MI",
"postal_code": "489123707",
"telephone_number": "517-913-3810",
"fax_number": "517-913-3811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUCOMMUN",
"first_name": "EDMOND",
"middle_name": "J.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-17",
"last_updated": "2019-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "MI",
"license": "4301059003",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHP",
"identifier": "200000001909",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCLAREN HEALTH PLAN-MEDICAID",
"identifier": "1010729",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4594007",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00464732",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHP FAMILYCARE",
"identifier": "200000001909",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD OF MICHIGAN",
"identifier": "0250331789",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCLAREN HEALTH PLAN-COMMERCIAL",
"identifier": "1010729",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4541831",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PLUS BLUE",
"identifier": "0M214400029",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCLAREN HEALTH ADVANTAGE",
"identifier": "1010729",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4848089",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lansing, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.