NPIMap

Individual provider Active NPI

Kelli Lynne Virgin, D.O.

  • Endocrinology, Diabetes & Metabolism Physician
  • Warren, MI
National Provider Identifier
1124464268
Registry record updated Oct 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
5101020536 Issued in MI
Practice address
11855 E 12 Mile Rd Ste 400
Warren, MI 48093-3471
Phone
(586) 586-6630
Fax
(586) 582-6631
NPI assigned
May 16, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 5101020536 MI
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 5101020536 MI Primary

Addresses

Primary practice location

11855 E 12 Mile Rd Ste 400
Warren, MI 48093-3471

Mailing address

500 Osborn Blvd
Sault Sainte Marie, MI 49783-1822
Phone (906) 253-0113

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181008001186 MI Practitioner - EndocrinologyPractitioner - Internal Medicine 7416240379 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Nova Southeastern College of Osteo Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mymichigan Medical Center SaultGroup PAC ID 7315936481, 101 clinicians

Practice addresses (Care Compare)

146 W Spruce St
Mymichigan Neurology
Sault Sainte Marie, MI 49783-1912
Phone (906) 253-0113

Hospital & facility affiliations

  • Chippewa County War Memorial Hospital Hospital, Sault Ste Marie, MI, CCN 230239
  • Helen Newberry Joy Hospital Hospital, Newberry, MI, CCN 231304
  • Mackinac Straits Hospital and Health Center Hospital, Saint Ignace, MI, CCN 231306
  • Schoolcraft Memorial Hospital Hospital, Manistique, MI, CCN 231303

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101020536MIMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mymichigan Medical Center Sault CurrentSince Sep 1, 2018 Accepting new patients
Mymichigan Medical Center Sault Current Accepting new patients
Mymichigan Medical Center Sault CurrentSince Sep 1, 2018 Accepting new patients
Mymichigan Medical Center Sault Past Accepting new patients

Locations

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

500 Osborn Blvd
Sault South Marie, MI 49783
Phone (906) 635-4350

146 W Spruce St
Sault South Marie, MI 49783
Phone (906) 253-2770

Interoperability endpoints

  • Direct secure messaging: kvirgin143498@mymichiganhealth.midirect.net

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 and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1368662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570060800000",
    "number": "1124464268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 OSBORN BLVD",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497831822",
            "telephone_number": "906-253-0113",
            "fax_number": "586-582-6631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11855 E 12 MILE RD STE 400",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933471",
            "telephone_number": "586-586-6630",
            "fax_number": "586-582-6631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIRGIN",
        "first_name": "KELLI",
        "middle_name": "LYNNE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-16",
        "last_updated": "2019-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101020536",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MI",
            "license": "5101020536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

Verify at the official NPI Registry.