Individual provider Active NPI

Timothy Edward O'Connor, M.D.

  • Family Medicine Physician
  • Sault Sainte Marie, MI
National Provider Identifier
1194813964
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301058216 Issued in MI
Practice address
333 Magazine St
Suite 102
Sault Sainte Marie, MI 49783-1867
Phone
(906) 253-9374
Fax
(906) 253-9002
NPI assigned
Oct 10, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 4301058216 MI Primary

Addresses

Primary practice location

333 Magazine St
Suite 102
Sault Sainte Marie, MI 49783-1867

Mailing address

333 Magazine St
Suite 102
Sault Sainte Marie, MI 49783-1867
Phone (906) 253-9374

Other identifiers 1

IdentifierTypeStateIssuer
4249083MedicaidMI

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
I20101110000653 MI Practitioner - Family Practice 3577697713 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Michigan Medical School, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mymichigan Medical Center SaultGroup PAC ID 7315936481, 101 clinicians

Practice addresses (Care Compare)

500 Osborn Blvd
Sault S Marie, MI 49783-1822
Phone (906) 635-4460

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Mymichigan Medical Center Sault Current Accepting new patients
Mymichigan Medical Center Sault CurrentSince Oct 15, 2018 Accepting new patients
Mymichigan Medical Center Sault Family Medicine CurrentSince Oct 15, 2018 Accepting new patients
Mymichigan Medical Center Sault Past Accepting new patients

Locations

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

333 Magazine St
Ste 102
Sault South Marie, MI 49783
Phone (906) 253-2605

500 Osborn Blvd
Sault South Marie, MI 49783
Phone (906) 635-4350

550 Osborn Blvd
Sault South Marie, MI 49783
Phone (906) 253-2665

333 Magazine St
Sault South Marie, MI 49783
Phone (906) 253-9374

Interoperability endpoints

  • Direct secure messaging: toconnor143506@mymichiganhealth.midirect.net

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194813964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 MAGAZINE ST",
            "address_2": "SUITE 102",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497831867",
            "telephone_number": "906-253-9374",
            "fax_number": "906-253-9002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 MAGAZINE ST",
            "address_2": "SUITE 102",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497831867",
            "telephone_number": "906-253-9374",
            "fax_number": "906-253-9002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'CONNOR",
        "first_name": "TIMOTHY",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301058216",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4249083",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sault Sainte Marie, MI

Sources for this page

Verify at the official NPI Registry.