Individual provider Active NPI

David A Patrick, DO

  • Diagnostic Radiology Physician
  • Jackson, MI
National Provider Identifier
1184643025
Registry record updated May 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
5101011343 Issued in MI
Practice address
205 N East Ave
Jackson, MI 49201-1753
Phone
(517) 205-4911
NPI assigned
Jul 19, 2006
Last updated
May 13, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 5101011343 MI Primary

Addresses

Primary practice location

205 N East Ave
Jackson, MI 49201-1753

Mailing address

1 Ford PL Ste 3a
Detroit, MI 48202-3450
Phone (313) 874-4806

Other practice location 1

4660 S Hagadorn Rd Ste 510
East Lansing, MI 48823-6805
Phone (517) 884-7450

Other practice location 2

3264 N Evergreen Dr NE
Grand Rapids, MI 49525-9746
Phone (616) 363-7272

Other practice location 3

4660 S Hagadorn Rd Ste 410
East Lansing, MI 48823-6819
Phone (517) 353-5053

Other practice location 4

3220 Discovery Dr Ste 100
Lansing, MI 48910-8609
Phone (517) 975-8950

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031222000689 MI Practitioner - Diagnostic Radiology 4587562020 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Michigan State University College of Human Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Radiology Services PCGroup PAC ID 4284546516, 252 clinicians
Msu Health Care Inc.Group PAC ID 8628404936, 201 clinicians

Practice addresses (Care Compare)

1187 Eastmont Dr SE
Grand Rapids, MI 49546-3737
Phone (616) 363-7272

4660 S Hagadorn Rd
Suite 410
East Lansing, MI 48823-6819
Phone (517) 353-5053

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101011343MIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
W.a. Foote Memorial Hospital CurrentSince May 1, 2025 Accepting new patients
Msu Health Care Inc. Diagnostic Radiology CurrentSince Oct 1, 2023 Accepting new patients
W.a. Foote Memorial Hospital CurrentSince May 1, 2025 Accepting new patients
Msu Health Care Inc. CurrentSince Oct 1, 2023 Accepting new patients
Msu Health Care Inc Current Accepting new patients
Wa Foote Memorial Hospital, Inc Current Accepting new patients
Memorial Hospital Past Accepting new patients
Lansing Radiology Associates P C Diagnostic Radiology Past Accepting new patients

Locations

1 Ford Pl
Ste 3A
Detroit, MI 48202
Phone (313) 874-4806

4650 S Hagadorn Rd
Ste 100
East Lansing, MI 48823
Phone (517) 353-4830

4660 S Hagadorn Rd
Ste 410
East Lansing, MI 48823
Phone (517) 884-6132

4660 S Hagadorn Rd
Ste 500
East Lansing, MI 48823
Phone (517) 432-6144

4660 S Hagadorn Rd
Ste 510
East Lansing, MI 48823
Phone (517) 884-7450

804 Service Rd
Ste A202
East Lansing, MI 48824
Phone (517) 884-2976

205 N East Ave
Jackson, MI 49201
Phone (517) 788-4730

1215 E Michigan Ave
Lansing, MI 48912
Phone (517) 336-8080

3220 Discovery Dr
Ste 100
Lansing, MI 48910
Phone (517) 975-8930

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747094400000",
    "number": "1184643025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 FORD PL STE 3A",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023450",
            "telephone_number": "313-874-4806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011753",
            "telephone_number": "517-205-4911"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4660 S Hagadorn Rd Ste 510",
            "address_purpose": "LOCATION",
            "city": "East Lansing",
            "state": "MI",
            "postal_code": "488236805",
            "country_code": "US",
            "telephone_number": "517-884-7450",
            "fax_number": "517-884-7460",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3264 N Evergreen Dr NE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495259746",
            "country_code": "US",
            "telephone_number": "616-363-7272",
            "fax_number": "616-363-7290",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4660 S Hagadorn Rd Ste 410",
            "address_purpose": "LOCATION",
            "city": "East Lansing",
            "state": "MI",
            "postal_code": "488236819",
            "country_code": "US",
            "telephone_number": "517-353-5053",
            "fax_number": "517-884-6236",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3220 Discovery Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Lansing",
            "state": "MI",
            "postal_code": "489108609",
            "country_code": "US",
            "telephone_number": "517-975-8950",
            "fax_number": "517-337-4985",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATRICK",
        "first_name": "DAVID",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "5101011343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

Verify at the official NPI Registry.