Active NPI
Willard Peter Debraber, D.O.
- Specialist
- Muskegon, MI
National Provider Identifier
1255334397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 5101006662
- Practice address
- 1761 Wells Ave
Muskegon, MI 49442-2459 - Phone
- (231) 773-3228
- Fax
- (231) 773-3482
- NPI assigned
- May 23, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 5101006662 | MI | Primary |
Addresses
Primary practice location
1761 Wells Ave
Muskegon, MI 49442-2459
Mailing address
1761 Wells Ave
Muskegon, MI 49442-2459
Phone (231) 773-3228
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101551 | Other | MI | PREFERRED CHOICES |
| 3456139255 | Other | MI | COMM |
| 1429 | Other | MI | PH |
| 103308 | Medicaid | MI | |
| 1910582 | Other | MI | UNITED HEALTHCARE |
| 3456110440 | Other | MI | BCR |
| P54169 | Other | MI | BCN |
| 2101067 | Medicaid | MI | |
| 4098761 | Other | MI | AETNA |
| 382273611 | Other | MI | COMM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101006662 | MI | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428364800000",
"number": "1255334397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1761 WELLS AVE",
"city": "MUSKEGON",
"state": "MI",
"postal_code": "494422459",
"telephone_number": "231-773-3228",
"fax_number": "231-773-3482"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1761 WELLS AVE",
"city": "MUSKEGON",
"state": "MI",
"postal_code": "494422459",
"telephone_number": "231-773-3228",
"fax_number": "231-773-3482"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEBRABER",
"first_name": "WILLARD",
"middle_name": "PETER",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-05-23",
"last_updated": "2015-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MI",
"license": "5101006662",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED CHOICES",
"identifier": "101551",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMM",
"identifier": "3456139255",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PH",
"identifier": "1429",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "103308",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "1910582",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCR",
"identifier": "3456110440",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCN",
"identifier": "P54169",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2101067",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4098761",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMM",
"identifier": "382273611",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Muskegon, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.