NPIMap

Individual provider Active NPI

Gary A James, D.O.

  • Family Medicine Physician
  • Kimball, MI
National Provider Identifier
1255317178
Registry record updated Jan 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101012784 Issued in MI
Practice address
5312 Lapeer Rd
Kimball, MI 48074-1424
Phone
(810) 984-2693
Fax
(810) 984-2669
NPI assigned
Dec 22, 2005
Last updated
Jan 11, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2010

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 5101012784 MI Primary

Addresses

Primary practice location

5312 Lapeer Rd
Kimball, MI 48074-1424

Mailing address

5312 Lapeer Rd
Kimball, MI 48074-1424
Phone (810) 984-2693

Other identifiers 1

IdentifierTypeStateIssuer
4696657MedicaidMI

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
I20050120000105 MI Practitioner - Family Practice 3971552647 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5312 Lapeer Rd
Kimball, MI 48074-1424
Phone (810) 984-2693

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101012784MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wadhams Family Care PLLC CurrentSince Jan 1, 2009 Accepting new patients
McLaren Port Huron Current Accepting new patients
McLaren Port Huron Family Medicine CurrentSince Jun 1, 2024 Accepting new patients
Blue Water OB & GYN PC PastSince Aug 1, 1999 Accepting new patients
Port Huron Mercy Family Care Inc PastSince Jan 1, 2009 Accepting new patients

Locations

5312 Lapeer Rd
Kimball, MI 48074
Phone (810) 984-2693

1216 Richardson St
Port Huron, MI 48060
Phone (810) 985-2640

1313 Stone St
Port Huron, MI 48060
Phone (810) 984-3181

1163 S Carney Dr
Saint Clair, MI 48079
Phone (810) 561-8450

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
McLaren Port HuronPort Huron, MI, CCN 230216 Hospital Corporate Director Feb 1, 2019
McLaren Port HuronPort Huron, MI, CCN 23S216 Hospital Corporate Director Feb 1, 2019

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263168000000",
    "number": "1255317178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5312 LAPEER RD",
            "city": "KIMBALL",
            "state": "MI",
            "postal_code": "480741424",
            "telephone_number": "810-984-2693",
            "fax_number": "810-984-2669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5312 LAPEER RD",
            "city": "KIMBALL",
            "state": "MI",
            "postal_code": "480741424",
            "telephone_number": "810-984-2693",
            "fax_number": "810-984-2669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAMES",
        "first_name": "GARY",
        "middle_name": "A",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-22",
        "last_updated": "2010-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101012784",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4696657",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kimball, MI

Sources for this page

Verify at the official NPI Registry.