NPIMap

Organization Active NPI

Lake Michigan Emergency Specialists, PLLC

  • Emergency Medicine Physician
  • Muskegon, MI
National Provider Identifier
1124574520
Registry record updated Apr 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
LAKE MICHIGAN EMERGENCY SPECIALISTS, PLLC
Practice address
1700 Clinton St
Emergency Department
Muskegon, MI 49442-5502
Phone
(231) 728-4601
NPI assigned
Aug 27, 2016
Last updated
Apr 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2022

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

Authorized official

Name
Dr. Marc WhitakerNPI 1013957992
Title
Board Member
Phone
(231) 728-4601

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

1700 Clinton St
Emergency Department
Muskegon, MI 49442-5502

Mailing address

800 E Ellis Rd Ste 571
Norton Shores, MI 49441-5622
Phone (231) 728-4601

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161123001655 MI Part B Supplier - Clinic/Group Practice 0749569242 Receives reassigned benefits from 124 practitioners
Practice locations: Grand Haven, MI; Muskegon, MI; Shelby, MI

National Provider Directory

National Provider Directory

Locations

800 E Ellis Rd
Ste 571
Norton Shores, MI 49441

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 125

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 125

NPI Registry JSON

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

{
    "created_epoch": "1472256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650240000000",
    "number": "1124574520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 E ELLIS RD STE 571",
            "city": "NORTON SHORES",
            "state": "MI",
            "postal_code": "494415622",
            "telephone_number": "231-728-4601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 CLINTON ST",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494425502",
            "telephone_number": "231-728-4601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MICHIGAN EMERGENCY SPECIALISTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-27",
        "last_updated": "2022-04-18",
        "certification_date": "2022-04-18",
        "status": "A",
        "authorized_official_last_name": "WHITAKER",
        "authorized_official_first_name": "MARC",
        "authorized_official_title_or_position": "BOARD MEMBER",
        "authorized_official_telephone_number": "231-728-4601",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskegon, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2022; 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.