Individual provider Active NPI

Michelle Stevenson

  • Registered Dietitian
  • Michigan City, IN
National Provider Identifier
1104827401
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
37000612 Issued in IN
Practice address
301 W Homer St
Michigan City, IN 46360-4358
Phone
(219) 877-1545
NPI assigned
Aug 9, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 37000612 IN Primary

Addresses

Primary practice location

301 W Homer St
Michigan City, IN 46360-4358

Mailing address

2515 Lake Shore Dr
Long Beach, IN 46360-1643

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

State licenses

LicenseStateTypeSpecialty
37000612INMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
St. Anthony Home Medical Equipment PastSince Jan 1, 1990 Accepting new patients
Franciscan Health Michigan City PastSince Jan 1, 1990 Accepting new patients
Franciscan Health Michigan City PastSince Jan 1, 1990 Accepting new patients
Franciscan Health Michigan City PastSince Jan 1, 1990 Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104827401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2515 LAKE SHORE DR",
            "city": "LONG BEACH",
            "state": "IN",
            "postal_code": "463601643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W HOMER ST",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "463604358",
            "telephone_number": "219-877-1545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEVENSON",
        "first_name": "MICHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IN",
            "license": "37000612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Michigan City, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.