Individual provider Active NPI

Kevin M Karadeema, D.C.

  • Chiropractor
  • Taylor, MI
National Provider Identifier
1124089339
Registry record updated Feb 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4356 Issued in AZ
Practice address
22908 Wick Rd
Suite B
Taylor, MI 48180-3589
Phone
(313) 295-7760
NPI assigned
Mar 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4356 AZ Primary
Chiropractor 111N00000X KKOO5272 MI

Addresses

Primary practice location

22908 Wick Rd
Suite B
Taylor, MI 48180-3589

Mailing address

22908 Wick Rd
Suite B
Taylor, MI 48180-3589
Phone (313) 295-7760

Other identifiers 2

IdentifierTypeStateIssuer
2736548MedicaidMI
95OH25311OtherMIPROVIDER ID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070409000029 MI Practitioner - Chiropractic 7719081314 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

22908 Wick Rd
Suite B
Taylor, MI 48180-3588
Phone (313) 295-7760

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
KKOO5272MIMDChiropractor
4356AZMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Kevin M Karadeema DC PC Chiropractor CurrentSince May 23, 1986 Accepting new patients

Locations

22908 Wick Rd
Ste B
Taylor, MI 48180
Phone (313) 295-7760

22908 Wick Rd
Taylor, MI 48180
Phone (313) 295-2660

Organizations & group practices 1

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": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581033600000",
    "number": "1124089339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22908 WICK RD",
            "address_2": "SUITE B",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481803589",
            "telephone_number": "313-295-7760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22908 WICK RD",
            "address_2": "SUITE B",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481803589",
            "telephone_number": "313-295-7760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KARADEEMA",
        "first_name": "KEVIN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2020-02-07",
        "certification_date": "2020-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "4356",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "KKOO5272",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2736548",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER ID",
            "identifier": "95OH25311",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Taylor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.