NPIMap

Individual provider Active NPI

Mark E Leventer, MD

  • Family Medicine Physician
  • Grass Lake, MI
National Provider Identifier
1174637995
Registry record updated Dec 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ML041377 Issued in MI
Practice address
12337 E Michigan Ave
Grass Lake, MI 49240-0246
Phone
(517) 522-8403
Fax
(517) 522-4275
NPI assigned
Aug 18, 2006
Last updated
Dec 23, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 23, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ML041377 MI Primary

Addresses

Primary practice location

12337 E Michigan Ave
Grass Lake, MI 49240-0246

Mailing address

PO Box 246
Grass Lake, MI 49240-0246
Phone (517) 522-8403

Other identifiers 18

IdentifierTypeStateIssuer
0803800311OtherMIBCBS
2126585MedicaidMI
383042885OtherCONSECO HEALTHCARE
383042885OtherCIGNA HEALTHCARE
383042885OtherCIGNA CONNECTICUT
383042885OtherCONSECO
0803800311OtherBCBS BLUE PREFERRED
0803800311OtherBCBS FEP PROGRAM
0803800311OtherBCBS BLUE CHOICE
0803800311OtherBLUE CHOICE
383042885OtherCIGNA CONNECTICUT GENERAL
0803800311OtherBCBS COMMUNITY BLUE
383042885OtherCONTINENTAL LIFE
383042885OtherCIGNA
0803800311OtherBCBS PPO
0803800311OtherBLUE CARE NETWORK
383042885OtherCORESOURCE
383042885OtherCONTINENTAL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mleventer444298@direct.hfhs.org W.A. Foote Memorial Hospital

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
I20100406000173 MI Practitioner - Family Practice 0547396236 Receives reassigned benefits from 2 practitioners
Practice locations: Grass Lake, MI

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Vanderbilt University School of Medicine, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

12337 E Michigan Ave
Grass Lake, MI 49240-9213
Phone (517) 522-8403

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ML041377MIMDFamily Medicine Physician

Practitioners & affiliated clinicians

Practitioners 2

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.

Hospital & facility affiliations 6

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": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608681600000",
    "number": "1174637995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 246",
            "city": "GRASS LAKE",
            "state": "MI",
            "postal_code": "492400246",
            "telephone_number": "517-522-8403",
            "fax_number": "517-522-4275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12337 E MICHIGAN AVE",
            "city": "GRASS LAKE",
            "state": "MI",
            "postal_code": "492400246",
            "telephone_number": "517-522-8403",
            "fax_number": "517-522-4275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEVENTER",
        "first_name": "MARK",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2020-12-23",
        "certification_date": "2020-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "ML041377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0803800311",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2126585",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONSECO HEALTHCARE",
            "identifier": "383042885",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA HEALTHCARE",
            "identifier": "383042885",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA CONNECTICUT",
            "identifier": "383042885",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONSECO",
            "identifier": "383042885",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS BLUE PREFERRED",
            "identifier": "0803800311",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FEP PROGRAM",
            "identifier": "0803800311",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS BLUE CHOICE",
            "identifier": "0803800311",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "0803800311",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA CONNECTICUT GENERAL",
            "identifier": "383042885",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS COMMUNITY BLUE",
            "identifier": "0803800311",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONTINENTAL LIFE",
            "identifier": "383042885",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "383042885",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PPO",
            "identifier": "0803800311",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "0803800311",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORESOURCE",
            "identifier": "383042885",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONTINENTAL",
            "identifier": "383042885",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mleventer444298@direct.hfhs.org",
            "affiliation": "Y",
            "affiliationName": "W.A. Foote Memorial Hospital",
            "address_1": "205 N East Ave",
            "address_2": "7th FL One Jackson Square",
            "city": "Jackson",
            "state": "MI",
            "country_code": "US",
            "postal_code": "49201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grass Lake, MI

Sources for this page

Verify at the official NPI Registry.