Diane B Ebaugh, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

DE046093 Issued in MI

Practice address

1005 W Green St
Suite 304
Hastings, MI 49058-1712

Phone

(269) 948-8057

Fax

(269) 948-8964

NPI assigned

Mar 27, 2006

Sex

Female

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 1

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

Family Practice

Education

Wayne State University School of Medicine, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Thornapple Valley Family Physicians PCGroup PAC ID 5698823250, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Corewell Health Pennock Hospital Hospital, Hastings, MI, CCN 231339
• Spectrum Health Hospital, Grand Rapids, MI, CCN 230038

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: dianeebaugh@tvfp.allscriptsdirect.net

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.

• Thornapple Valley Family Physicians PC

  • Family Medicine Physician
  • Hastings, MI
  • NPI 1528268513
  Medicare reassignment Care Compare group Authorized official
• Frances Mahon Deaconess Hospital

  • Critical Access Hospital
  • Glasgow, MT
  • NPI 1689685323
  NPD (past)

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

• Pennock Hospital

  • Critical Access Hospital
  • Hastings, MI
  • NPI 1932695525
  Care Compare affiliation
• Spectrum Health Hospitals

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1922090554
  Care Compare affiliation

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455840000000",
    "number": "1215997796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 W GREEN ST",
            "address_2": "SUITE 304",
            "city": "HASTINGS",
            "state": "MI",
            "postal_code": "490581712",
            "telephone_number": "269-948-8057",
            "fax_number": "269-948-8964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 W GREEN ST",
            "address_2": "SUITE 304",
            "city": "HASTINGS",
            "state": "MI",
            "postal_code": "490581712",
            "telephone_number": "269-948-8057",
            "fax_number": "269-948-8964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBAUGH",
        "first_name": "DIANE",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-27",
        "last_updated": "2016-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "DE046093",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1535189",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexie Doyle, RMA
• Sally Ann Dull, CTRS
• Mandy Louise Dutter
• Sue Ellen Eastman, LMSW
• Jayne M Eaton
• Owen Eckardt, PHARMD
• Steven R Eernisse, P.A.-C
• Donald G Eichholz, PHARMD
• Eldon E Cassell MD PC
• Annalyse Ellis, LMSW, CMHP, CAADC

• Family Medicine Physician in Hastings, MI
• Providers in Hastings, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2016; 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.