Sixty Fourth Street LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SIXTY FOURTH STREET LLC

Practice address

2373 64TH St SW
Suite 2200
Byron Center, MI 49315-7974

Phone

(616) 685-3975

Fax

(616) 685-3977

NPI assigned

Aug 22, 2006

Organization subpart

No

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

Authorized official

Name

Andrew Livingston, MD

Title

Medical Director

Phone

(616) 685-3975

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Listed as

Sixty Fourth Street LLCCCN 23C0001079

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Trinity Health - Michigan

  • Community/Retail Pharmacy
  • Ann Arbor, MI
  • NPI 1417029034

  Member Of

  NPD member

Locations

Practitioners 1

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

• Timothy D Henne, M.D.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Byron Center, MI
  • NPI 1730125428
  NPD

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524441600000",
    "number": "1164538286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2373 64TH ST SW",
            "address_2": "SUITE 2200",
            "city": "BYRON CENTER",
            "state": "MI",
            "postal_code": "493157974",
            "telephone_number": "616-685-3975",
            "fax_number": "616-685-3977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2373 64TH ST SW",
            "address_2": "SUITE 2200",
            "city": "BYRON CENTER",
            "state": "MI",
            "postal_code": "493157974",
            "telephone_number": "616-685-3975",
            "fax_number": "616-685-3977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIXTY FOURTH STREET LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2018-04-23",
        "status": "A",
        "authorized_official_last_name": "LIVINGSTON",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "616-685-3975",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adrienne Chabot Shane, PA-C
• Victoria Paige Sheffer, LMSW, CAADC
• Chad Mills Shelner, NP
• Joanne Phillips Sherwood, ANP
• Melinda Simon, M.S.P.T., A.T., C.
• Andrew Mark Skowronek, NP
• Audrey Sleep, PHARMD
• Smith Rehabilitation Counseling, LLC
• Ana Marie Snow, LLPC
• Snyder Family Dentistry PLLC

• Ambulatory Surgical Clinic/Center in Byron Center, MI
• Providers in Byron Center, MI by specialty
• Ambulatory Surgical Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2018; 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.