Douglas John Raedy, D.O

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

DR009649 Issued in MI

Practice address

3850 Glenkerry CT
Portage, MI 49024-0700

Phone

(269) 327-7200

Fax

(269) 327-9272

NPI assigned

Dec 19, 2007

Last updated

May 10, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Specialty

OtolaryngologyAlso: Allergy/Immunology

Education

Other, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bronson Methodist Hospital Hospital, Kalamazoo, MI, CCN 230017
• Three Rivers Health Hospital, Three Rivers, MI, CCN 230015
• Borgess Medical Center Hospital, Kalamazoo, MI, CCN 230117

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: douglas.raedy.1@30883.direct.athenahealth.com

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.

• Three Rivers Health System, Inc

  dba Three Rivers Health Family Care White Pigeon

  • Rural Health Clinic/Center
  • White Pigeon, MI
  • NPI 1720350903
  Medicare reassignment NPD
• West Michigan Ear Nose & Throat PLC

  dba Douglas Ready DO

  • Otolaryngology Physician
  • Portage, MI
  • NPI 1154365849
  Medicare reassignment
• Three Rivers Health System, Inc

  dba Three Rivers Health Infectious Disease

  • Infectious Disease Physician
  • Three Rivers, MI
  • NPI 1346874070
  NPD
• Three Rivers Health System, Inc

  dba Three Rivers Health Hospice

  • Community Based Hospice Care Agency
  • Three Rivers, MI
  • NPI 1366714552
  NPD

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

• Beacon Kalamazoo Inc

  dba Beacon Kalamazoo

  • General Acute Care Hospital
  • Kalamazoo, MI
  • NPI 1568416311
  Care Compare affiliation
• Bronson Methodist Hospital

  • General Acute Care Hospital
  • Kalamazoo, MI
  • NPI 1831116441
  Care Compare affiliation
• Three Rivers Health System, Inc

  dba Three Rivers Health

  • General Acute Care Hospital
  • Three Rivers, MI
  • NPI 1568739423
  Care Compare affiliation

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

{
    "created_epoch": "1198022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304985600000",
    "number": "1215111885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3850 GLENKERRY CT",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490240700",
            "telephone_number": "269-327-7200",
            "fax_number": "269-327-9272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 GLENKERRY CT",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490240700",
            "telephone_number": "269-327-7200",
            "fax_number": "269-327-9272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAEDY",
        "first_name": "DOUGLAS",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-12-19",
        "last_updated": "2011-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MI",
            "license": "DR009649",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2745903",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELDI",
            "identifier": "1753900045",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Todd Pushee
• Christopher Quertermus, CRNA
• Derek James Quinn, PHARM.D., R.PH.
• Timothy Lewis Radabaugh, MA, LLP
• Sarah Radke
• Rahaf Kanawati Dental PC (Portage Dental office)
• Alyssa Ramsey
• Jason Randall, PSYD
• Shelby Randall
• Ryan Michael Ranger, LLMSW

• Otolaryngology Physician in Portage, MI
• Providers in Portage, MI by specialty
• Otolaryngology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.