NPIMap

Individual provider Active NPI

Megan Jillaine Dutcher-Cisneros, D.O.

  • Emergency Medicine Physician
  • Grand Rapids, MI
National Provider Identifier
1205215308
Registry record updated Jul 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
5101021687 Issued in MI
Practice address
4100 Embassy Drive SE
Suite 400
Grand Rapids, MI 49546
Phone
(616) 285-8075
NPI assigned
May 21, 2015
Last updated
Jul 11, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 5101021687 MI Primary

Addresses

Primary practice location

4100 Embassy Drive SE
Suite 400
Grand Rapids, MI 49546

Mailing address

4100 Embassy Drive SE
Suite 400
Grand Rapids, MI 49546
Phone (989) 583-6817

Other names 1

  • Megan Jillaine Dutcher Former name

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
I20170925002251 MI Practitioner - Emergency Medicine 4981902160 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Michigan State University College of Osteopathic Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ecs Western Michigan PCGroup PAC ID 8628327384, 202 clinicians

Practice addresses (Care Compare)

1 Atkinson Dr
Ludington, MI 49431-1906
Phone (231) 843-2591

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Deckerville Community Hospital, Inc CurrentSince Apr 15, 2018 Accepting new patients
Deckerville Community Hospital, Inc. Emergency Medicine CurrentSince Apr 15, 2018 Accepting new patients
Degara App, PLLC Emergency Medicine CurrentSince Aug 20, 2017 Accepting new patients
Marlette Regional Hospital Current Accepting new patients
Covenant Medical Center, Inc. CurrentSince Jul 1, 2018 Accepting new patients
Marlette Regional Hospital Emergency Medicine CurrentSince Sep 5, 2018 Accepting new patients
Covenant Medical Center, Inc CurrentSince Jul 1, 2018 Accepting new patients
Marlette Regional Hospital CurrentSince Sep 5, 2018 Accepting new patients
Covenant Medical Center, Inc. Emergency Medicine Current Accepting new patients
Ecs Western Michigan PC Emergency Medicine CurrentSince May 1, 2021 Accepting new patients

Locations

3559 Pine St
Deckerville, MI 48427
Phone (810) 376-2835

212 S Sullivan Ave
Fremont, MI 49412
Phone (231) 924-1212

615 S Bower St
Greenville, MI 48838
Phone (616) 754-4341

401 W Greenlawn Ave
Lansing, MI 48910
Phone (517) 334-2286

1 Atkinson Dr
Ludington, MI 49431
Phone (231) 843-2591

2770 Main St
Marlette, MI 48453
Phone (989) 635-4000

50 N Perry St
Pontiac, MI 48342
Phone (248) 338-5300

1447 N Harrison St
Saginaw, MI 48602
Phone (989) 583-4220

900 Cooper Ave
Saginaw, MI 48602
Phone (989) 583-6122

Organizations & group practices 10

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 2

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": "1432166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689033600000",
    "number": "1205215308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 EMBASSY DRIVE SE",
            "address_2": "SUITE 400",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49546",
            "telephone_number": "989-583-6817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 EMBASSY DRIVE SE",
            "address_2": "SUITE 400",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49546",
            "telephone_number": "616-285-8075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUTCHER-CISNEROS",
        "first_name": "MEGAN",
        "middle_name": "JILLAINE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-21",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101021687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MEGAN",
            "last_name": "DUTCHER",
            "middle_name": "JILLAINE",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.