Individual provider Active NPI

Daniel K Borreson, M.D.

  • Surgery Physician
  • Wyoming, MI
National Provider Identifier
1245211796
Registry record updated Jul 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
4301041912 Issued in MI
Practice address
1045 Gezon Pkwy SW
Wyoming, MI 49509
Phone
(616) 456-5311
Fax
(616) 456-7955
NPI assigned
Nov 10, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 4301041912 MI Primary

Addresses

Primary practice location

1045 Gezon Pkwy SW
Wyoming, MI 49509

Mailing address

1045 Gezon Pkwy SW
Wyoming, MI 49509-9542
Phone (616) 456-5311

Other identifiers 2

IdentifierTypeStateIssuer
0D16117OtherMIBCBS
2608575MedicaidMI

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
I20060830000397 MI Practitioner - General Surgery 9739106568 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health/Saint Mary'S Medical Group CurrentSince Aug 1, 2013 Accepting new patients
Advantage Health/Saint Mary'S Medical Group Current Accepting new patients
West Michigan Surgical Specialists PLC Surgery CurrentSince Apr 1, 2003 Accepting new patients
Advantage Health Saint Mary'S Medical Group CurrentSince Aug 1, 2013 Accepting new patients
Advantage Health Saint Mary'S Medical Group PastSince Apr 1, 2003 Accepting new patients

Locations

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

245 State St SE
Ste 1A
Grand Rapids, MI 49503

1045 Gezon Pkwy SW
Wyoming, MI 49509
Phone (616) 456-5311

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.

NPI Registry JSON

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531440000000",
    "number": "1245211796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 GEZON PKWY SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495099542",
            "telephone_number": "616-456-5311",
            "fax_number": "616-456-7955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 GEZON PKWY SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "49509",
            "telephone_number": "616-456-5311",
            "fax_number": "616-456-7955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORRESON",
        "first_name": "DANIEL",
        "middle_name": "K",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-10",
        "last_updated": "2018-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301041912",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0D16117",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2608575",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyoming, MI

Sources for this page

Verify at the official NPI Registry.