NPIMap

Organization Active NPI

Southwest Michigan Center for Orthopaedic and Sports Medicine P

  • Specialist
  • Saint Joseph, MI
National Provider Identifier
1104913094
Registry record updated Apr 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
SOUTHWEST MICHIGAN CENTER FOR ORTHOPAEDIC AND SPORTS MEDICINE P
Practice address
183 Peace Blvd
Saint Joseph, MI 49085-9146
Phone
(269) 428-3500
Fax
(269) 429-6429
NPI assigned
Oct 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2009

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

Authorized official

Name
Dr. Kenneth J Edwards, M.D.
Title
Managing Partner
Phone
(269) 428-3500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

183 Peace Blvd
Saint Joseph, MI 49085-9146

Mailing address

183 Peace Blvd
Saint Joseph, MI 49085-9146
Phone (269) 428-3500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040206000083 MI Part B Supplier - Clinic/Group Practice 5890688444 Receives reassigned benefits from 17 practitioners
Practice locations: Saint Joseph, MI

National Provider Directory

National Provider Directory

Locations

183 Peace Blvd
Ste 101
Saint Joseph, MI 49085

183 Peace Blvd
Saint Joseph, MI 49085
Phone (269) 408-1636

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240272000000",
    "number": "1104913094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "183 PEACE BLVD",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859146",
            "telephone_number": "269-428-3500",
            "fax_number": "269-429-6429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "183 PEACE BLVD",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859146",
            "telephone_number": "269-428-3500",
            "fax_number": "269-429-6429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST MICHIGAN CENTER FOR ORTHOPAEDIC AND SPORTS MEDICINE P",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2009-04-21",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "269-428-3500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.