Individual provider Active NPI

Bridget M Pekrul, M.D.

  • Pediatrics Physician
  • Ann Arbor, MI
National Provider Identifier
1124225990
Registry record updated Jun 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4301090110 Issued in MI
Practice address
1500 E Medical Center Drive
12TH Floor CS Mott Childrens Hospital Room 525
Ann Arbor, MI 48109-4280
Phone
(734) 763-5302
NPI assigned
Jun 27, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2015

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301090110 MI
Pediatrics Physician 208000000X 4301090110 MI Primary
Pediatric Hospice and Palliative Medicine Physician 2080H0002X 4301090110 MI
Student in an Organized Health Care Education/Training Program 390200000X 43301090110 MI

Addresses

Primary practice location

1500 E Medical Center Drive
12TH Floor CS Mott Childrens Hospital Room 525
Ann Arbor, MI 48109-4280

Mailing address

3621 S State St
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20171013000158 MD Practitioner - Hospice/Palliative CarePractitioner - Internal MedicinePractitioner - Pediatric Medicine 1951579689 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
43301090110MIMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Greater Baltimore Medical Center, Inc. CurrentSince Aug 12, 2017 Accepting new patients
Gilchrist Hospice Care, Inc. CurrentSince Jul 1, 2019 Accepting new patients
Greater Baltimore Medical Center, Inc Current Accepting new patients
Gilchrist Hospice Care, Inc. CurrentSince Jul 1, 2019 Accepting new patients
Greater Baltimore Medical Center, Inc. CurrentSince Aug 12, 2017 Accepting new patients

Locations

6569 N Charles St
Ste 307
Towson, MD 21204
Phone (443) 849-2767

6701 N Charles St
Ste 4105
Towson, MD 21204
Phone (443) 849-3184

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434412800000",
    "number": "1124225990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E MEDICAL CENTER DRIVE",
            "address_2": "12TH FLOOR CS MOTT CHILDRENS HOSPITAL ROOM 525",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481094280",
            "telephone_number": "734-763-5302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEKRUL",
        "first_name": "BRIDGET",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-27",
        "last_updated": "2015-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301090110",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301090110",
            "primary": true
        },
        {
            "code": "2080H0002X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Hospice and Palliative Medicine",
            "state": "MI",
            "license": "4301090110",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "43301090110",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.