NPIMap

Individual provider Active NPI

Dalton Enrico Latham, NP- NURSE PRACTITION

  • Adult Health Nurse Practitioner
  • Berrien Springs, MI
National Provider Identifier
1194291179
Registry record updated Oct 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
4704211443 Issued in MI
Practice address
8521 Kephart Lane
Berrien Springs, MI 49103
Phone
(269) 277-3260
NPI assigned
Oct 17, 2018
Last updated
Oct 17, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 4704211443 MI Primary
Family Nurse Practitioner 363LF0000X 4704211443 MI

Addresses

Primary practice location

8521 Kephart Lane
Berrien Springs, MI 49103

Mailing address

8521 Kephart Lane
Berrien Springs, MI 49103
Phone (269) 277-3260

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20191023002325 TX Practitioner - Nurse Practitioner 5991037061 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

119 S 1St Ave
Martin, SD 57551-5835
Phone (605) 867-3313

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.38 of 100Reported as group
Quality
80.82
Promoting interoperability
91
Improvement activities
40
Cost
84.44

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704211443MIMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Ridge Indian Health Service Hospital CurrentSince Jul 19, 2021 Accepting new patients
Pine Ridge Indian Health Service Hospital CurrentSince Mar 16, 2022 Accepting new patients
Pine Ridge Indian Health Service Hospital Current Accepting new patients
Pine Ridge Indian Health Service Hospital Current Accepting new patients
Pine Ridge Indian Health Service Hospital CurrentSince Jul 19, 2021 Accepting new patients

Locations

119 S 1st Ave
Martin, SD 57551
Phone (605) 685-2800

Organizations & group practices 5

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 18

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1539734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539734400000",
    "number": "1194291179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8521 KEPHART LANE",
            "city": "BERRIEN SPRINGS",
            "state": "MI",
            "postal_code": "49103",
            "telephone_number": "269-277-3260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8521 KEPHART LANE",
            "city": "BERRIEN SPRINGS",
            "state": "MI",
            "postal_code": "49103",
            "telephone_number": "269-277-3260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATHAM",
        "first_name": "DALTON",
        "middle_name": "ENRICO",
        "name_prefix": "Mr.",
        "credential": "NP- NURSE PRACTITION",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-17",
        "last_updated": "2018-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MI",
            "license": "4704211443",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704211443",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berrien Springs, MI

Sources for this page

Verify at the official NPI Registry.