Individual provider Active NPI

Elizabeth Ann McGlothlin, M.D.

  • Family Medicine Physician
  • Niles, MI
National Provider Identifier
1124394945
Registry record updated Mar 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301108540 Issued in MI
Practice address
2002 S 11TH St
Niles, MI 49120-4074
Phone
(269) 687-0200
Fax
(269) 684-0199
NPI assigned
Mar 26, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301108540 MI Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

2002 S 11TH St
Niles, MI 49120-4074

Mailing address

2002 S 11TH St
Niles, MI 49120-4074
Phone (269) 687-0200

Other identifiers 1

IdentifierTypeStateIssuer
1124394945MedicaidMI

Other names 1

  • Elizabeth Ann Weage Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20150818005941 MI Practitioner - Family Practice 9931414000 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeland Community Hospital WatervlietGroup PAC ID 7416942750, shared by 7 NPIs, 66 clinicians

Practice addresses (Care Compare)

2002 S 11TH St
Niles, MI 49120-4074
Phone (269) 687-0200

Hospital & facility affiliations

  • Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021
  • Corewell Health Watervliet Hospital Hospital, Watervliet, MI, CCN 230078

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301108540MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeland Medical Practices CurrentSince Oct 1, 2016 Accepting new patients
Lakeland Community Hospital Watervliet CurrentSince Aug 31, 2015 Accepting new patients
Lakeland Community Hospital Watervliet CurrentSince Aug 31, 2015 Accepting new patients
Lakeland Community Hospital Watervliet Family Medicine Current Accepting new patients
Lakeland Community Hospital Watervliet Family Medicine CurrentSince Aug 31, 2015 Accepting new patients
Lakeland Medical Practices CurrentSince Oct 1, 2016 Accepting new patients

Locations

1045 E Front St
Ste A
Buchanan, MI 49107
Phone (269) 695-5540

1045 E Front St
Buchanan, MI 49107
Phone (269) 695-5540

7040 Red Arrow Hwy
Coloma, MI 49038
Phone (269) 468-4318

2002 S 11th St
Niles, MI 49120
Phone (269) 687-0200

3950 Hollywood Rd
Ste 280
Saint Joseph, MI 49085
Phone (269) 408-0990

400 Medical Park Dr
Watervliet, MI 49098
Phone (269) 463-3111

Interoperability endpoints

  • Direct secure messaging: eweage22555@lakeland.midirect.net
  • Direct secure messaging: emcglothlin1270783@epic00.corewelldirect.org
  • FHIR API: https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/R4/

Organizations & group practices 6

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1332720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553472000000",
    "number": "1124394945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 S 11TH ST",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491204074",
            "telephone_number": "269-687-0200",
            "fax_number": "269-684-0199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 S 11TH ST",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491204074",
            "telephone_number": "269-687-0200",
            "fax_number": "269-684-0199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCGLOTHLIN",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-26",
        "last_updated": "2019-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301108540",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124394945",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "WEAGE",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Niles, MI

Sources for this page

Verify at the official NPI Registry.