Mark Alan Richmond, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301058393 Issued in MI

Practice address

2810 Charlevoix Ave
Petoskey, MI 49770

Phone

(231) 881-9054

Fax

(231) 881-9052

NPI assigned

Jun 30, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 1, 2025 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Internal Medicine of Northern Michigan Laboratory

  • Clinical Medical Laboratory
  • Petoskey, MI
  • NPI 1801150453
  NPD

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737590400000",
    "number": "1144227653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2810 CHARLEVOIX AVE,",
            "address_2": "SUITE 104",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "49770",
            "telephone_number": "231-881-9054",
            "fax_number": "231-881-9052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 CHARLEVOIX AVE",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "49770",
            "telephone_number": "231-881-9054",
            "fax_number": "231-881-9052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHMOND",
        "first_name": "MARK",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-30",
        "last_updated": "2025-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301058393",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104085730",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Craig Allan Reynolds, DO
• Robin L Reynolds, M.A.
• Jason M Ricci, MD
• Stacie Jeanne Richard Schumann, MA, LPC
• Aaliyah Richards
• Patrick D Richmond, DPM
• Riley J. Turcott, O.D., PLC
• Tara Riley
• William K Riordan, DO
• Rite Aid of Michigan Inc

• Internal Medicine Physician in Petoskey, MI
• Providers in Petoskey, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.