Individual provider Active NPI

Peyton Paul Faganel, DO

  • Internal Medicine Physician
  • Muskegon, MI
National Provider Identifier
1104311604
Registry record updated Apr 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5101024308 Issued in MI
Practice address
1675 Leahy St Ste 201a
Muskegon, MI 49442
Phone
(231) 672-7800
NPI assigned
Jun 27, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 29, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 92744 MT
Internal Medicine Physician 207R00000X 5101024308 MI Primary
Internal Medicine Physician 207R00000X 92744 MT

Addresses

Primary practice location

1675 Leahy St Ste 201a
Muskegon, MI 49442

Mailing address

32 Meadows Dr
Norton Shores, MI 49444-7786
Phone (319) 329-6764

Other practice location 1

1675 Leahy St Ste 315A
Muskegon, MI 49442-5543
Phone (231) 727-5247

Other practice location 2

310 Sunnyview Ln
Kalispell, MT 59901-3129
Phone (406) 752-5111

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address krmcmedicalrecords@krhdirect.org Kalispell Regional Medical Center Inc

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210706002692 MT Practitioner - Internal Medicine 0143622720 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

310 Sunnyview LN
Kalispell, MT 59901-3129
Phone (406) 751-6488

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101024308MIMDInternal Medicine Physician
92744MTMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kalispell Regional Medical Center Inc CurrentSince Jul 15, 2021 Accepting new patients
Kalispell Regional Medical Center Inc Current Accepting new patients
Kalispell Regional Medical Center, Inc CurrentSince Jul 15, 2021 Accepting new patients
Glacier Regional Pathology, LTD. Current Accepting new patients
Kalispell Regional Medical Center Inc Current Accepting new patients

Locations

350 Heritage Way
Ste 2100
Kalispell, MT 59901
Phone (406) 257-8992

310 Sunnyview Ln
Kalispell, MT 59901
Phone (406) 751-5310

Interoperability endpoints

  • Direct secure messaging: krmcmedicalrecords@krhdirect.org

Organizations & group practices 5

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.

Hospital & facility affiliations 7

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": "1530057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619654400000",
    "number": "1104311604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 MEADOWS DR",
            "city": "NORTON SHORES",
            "state": "MI",
            "postal_code": "494447786",
            "telephone_number": "319-329-6764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 LEAHY ST STE 201A",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "49442",
            "telephone_number": "231-672-7800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1675 Leahy St Ste 315A",
            "address_purpose": "LOCATION",
            "city": "Muskegon",
            "state": "MI",
            "postal_code": "494425543",
            "country_code": "US",
            "telephone_number": "231-727-5247",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "310 Sunnyview Ln",
            "address_purpose": "LOCATION",
            "city": "Kalispell",
            "state": "MT",
            "postal_code": "599013129",
            "country_code": "US",
            "telephone_number": "406-752-5111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAGANEL",
        "first_name": "PEYTON",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-27",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MT",
            "license": "92744",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101024308",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MT",
            "license": "92744",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krmcmedicalrecords@krhdirect.org",
            "affiliation": "Y",
            "affiliationName": "Kalispell Regional Medical Center Inc",
            "address_1": "310 Sunnyview Ln",
            "city": "Kalispell",
            "state": "MT",
            "country_code": "US",
            "postal_code": "599013129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Muskegon, MI

Sources for this page

Verify at the official NPI Registry.