Individual provider Active NPI

Brian G Waite, MD

  • Family Medicine Physician
  • Marquette, MI
National Provider Identifier
1205880085
Registry record updated Apr 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301068433 Issued in MI
Practice address
1414 W Fair Ave
Suite 36
Marquette, MI 49855-2675
Phone
(906) 225-3867
Fax
(906) 225-7667
NPI assigned
May 19, 2006
Last updated
Apr 22, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2009

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 4301068433 MI Primary

Addresses

Primary practice location

1414 W Fair Ave
Suite 36
Marquette, MI 49855-2675

Mailing address

4602 Dept
Carol Stream, IL 60122-0021
Phone (906) 225-3867

Other identifiers 1

IdentifierTypeStateIssuer
0805211261OtherMIBCBSM

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
I20080324000202 MI Practitioner - Family Practice 5092812982 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Washington School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1414 W Fair Ave
Marquette, MI 49855-2675

850 W Baraga Ave
Marquette, MI 49855-4550

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
DLP Marquette Physician Practices Inc CurrentSince Sep 1, 2012 Accepting new patients
DLP Marquette Physician Practices Inc Family Medicine CurrentSince Sep 1, 2012 Accepting new patients
DLP Marquette Physician Practices Inc Past Accepting new patients
DLP Marquette General Hospital LLC Past Accepting new patients

Locations

1414 W Fair Ave
Ste 36
Marquette, MI 49855
Phone (906) 225-3864

580 W College Ave
Marquette, MI 49855
Phone (906) 225-3131

Organizations & group practices 4

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 1

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": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240358400000",
    "number": "1205880085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4602 DEPT",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601220021",
            "telephone_number": "906-225-3867",
            "fax_number": "906-225-7667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 W FAIR AVE",
            "address_2": "SUITE 36",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498552675",
            "telephone_number": "906-225-3867",
            "fax_number": "906-225-7667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAITE",
        "first_name": "BRIAN",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2009-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301068433",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0805211261",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marquette, MI

Sources for this page

Verify at the official NPI Registry.