NPIMap

Organization Active NPI

Certified Emergency Medicine Specialists, PC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Wyoming, MI
National Provider Identifier
1104985001
Registry record updated Mar 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
Legal business name
CERTIFIED EMERGENCY MEDICINE SPECIALISTS, PC
Practice address
5900 Byron Center Ave SW
Wyoming, MI 49519
Phone
(616) 363-7867
Fax
(616) 363-9432
NPI assigned
Dec 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2017

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

Authorized official

Name
Mrs. Sonya D Wilson
Title
Provider Credentialing
Phone
(616) 363-7867

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207PE0004X MI Primary

Addresses

Primary practice location

5900 Byron Center Ave SW
Wyoming, MI 49519

Mailing address

PO Box 72011
Cleveland, OH 44192-0002
Phone (616) 363-7867

Other identifiers 2

IdentifierTypeStateIssuer
9300412441OtherMIRAILROAD MEDICARE
1002854OtherMICOMMUNITY HEALTH PLANS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040908001374 MI Part B Supplier - Clinic/Group Practice 6204802895 Receives reassigned benefits from 27 practitioners
Practice locations: Wyoming, MI

National Provider Directory

National Provider Directory

Locations

4433 Byron Center Ave SW
Wyoming, MI 49519
Phone (616) 261-5189

Practitioners & affiliated clinicians

Practitioners 32

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

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489449600000",
    "number": "1104985001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 72011",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441920002",
            "telephone_number": "616-363-7867",
            "fax_number": "616-363-9432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 BYRON CENTER AVE SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "49519",
            "telephone_number": "616-363-7867",
            "fax_number": "616-363-9432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CERTIFIED EMERGENCY MEDICINE SPECIALISTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2017-03-14",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "SONYA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PROVIDER CREDENTIALING",
        "authorized_official_telephone_number": "616-363-7867",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "9300412441",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY HEALTH PLANS",
            "identifier": "1002854",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyoming, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2017; 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.