Board of Trustees of Michigan State University

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

BOARD OF TRUSTEES OF MICHIGAN STATE UNIVERSITY

Practice address

463 E Circle Dr
East Lansing, MI 48824-7500

Phone

(517) 355-8237

Fax

(517) 432-0457

NPI assigned

Nov 3, 2006

Organization subpart

No

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

Authorized official

Name

Lisa Rucker

Title

Enrollment & PT Accts Supervisor

Phone

(517) 884-2976

Specialties & licenses 1

Addresses

Other names 2

• MSU Laboratory - Olin - SHS Doing business as
• Michigan State University Doing business as

Medicare fee-for-service enrollment

Enrolled in MI2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Michigan State University

  • Student Health Clinic/Center
  • East Lansing, MI
  • NPI 1770646028

  3870405954

  Same PAC ID
• Michigan State University

  • Family Medicine Physician
  • East Lansing, MI
  • NPI 1861443269

  3870405954

  Same PAC ID
• Michigan State University

  • Diagnostic Radiology Physician
  • East Lansing, MI
  • NPI 1891747614

  3870405954

  Same PAC ID

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Board of Trustees of Michigan State University

  • Clinical Medical Laboratory
  • East Lansing, MI
  • NPI 1629157979

  O20040416000028

  Same enrollment
• Michigan State University

  • Student Health Clinic/Center
  • East Lansing, MI
  • NPI 1770646028

  O20031218000451

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Farha Zaman Abbasi, M.D.

  • Psychiatry Physician
  • East Lansing, MI
  • NPI 1689881781
  NPD
• Jonathan G Gold, M.D.

  • Pediatrics Physician
  • East Lansing, MI
  • NPI 1881602316
  NPD
• Lee Ming-Li Wang, MD

  • Psychiatry Physician
  • East Lansing, MI
  • NPI 1306870985
  NPD

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622764800000",
    "number": "1144309642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 SERVICE RD RM A109B",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247015",
            "telephone_number": "517-884-2976",
            "fax_number": "517-432-3928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "463 E CIRCLE DR",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247500",
            "telephone_number": "517-355-8237",
            "fax_number": "517-432-0457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOARD OF TRUSTEES OF MICHIGAN STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2021-06-04",
        "certification_date": "2021-06-04",
        "status": "A",
        "authorized_official_last_name": "RUCKER",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "ENROLLMENT & PT ACCTS SUPERVISOR",
        "authorized_official_telephone_number": "517-884-2976"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MSU Laboratory - Olin - SHS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Michigan State University",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kassie Blok, LLSLP
• Bloom and Balance PLLC
• Blue Care Network Pharmacy
• Natalie Blunt, PTA
• Jaida Leigh Boals
• Board of Trustees of Michigan State University
• Board of Trustees of Michigan State University
• Board of Trustees of Michigan State University
• Mindy Beth Boase, CTRS, CBIS
• Sean Boatman

• Clinical Medical Laboratory in East Lansing, MI
• Providers in East Lansing, MI by specialty
• Clinical Medical Laboratory in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.