NPIMap

Individual provider Active NPI

Kevin Bradley Lodewyk, MD

  • Ophthalmology Physician
  • Gaylord, MI
National Provider Identifier
1255851952
Registry record updated Dec 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
4301506618 Issued in MI
Practice address
350 W North St
Gaylord, MI 49735-1525
Phone
(989) 732-6455
NPI assigned
Jun 23, 2017
Last updated
Dec 15, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 4301112664 MI
Ophthalmology Physician 207W00000X 4301506618 MI Primary

Addresses

Primary practice location

350 W North St
Gaylord, MI 49735-1525

Mailing address

PO Box 1665
Gaylord, MI 49734-5665
Phone (989) 732-6455

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address klodewyk@alpineeyecare.direct.medflow.net Direct

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
I20220418001254 MI Practitioner - Ophthalmology 1850661059 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Wayne State University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jeffrey K Chaulk MD PCGroup PAC ID 6305947458, 5 clinicians

Practice addresses (Care Compare)

350 N St
Gaylord, MI 49735-1525
Phone (989) 732-6455

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.39 of 100Reported as group
Quality
89.51
Improvement activities
40
Cost
71.97

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery555

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301506618MIMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alpine Eye Care, PC Ophthalmology CurrentSince Jun 1, 2022 Accepting new patients
Jeffrey K Chaulk MD PC Ophthalmology CurrentSince Jun 1, 2022 Accepting new patients
Michigan Medical Patient Care Past Accepting new patients

Locations

724 S Main St
Cheboygan, MI 49721
Phone (231) 445-9119

350 W North St
Gaylord, MI 49735
Phone (517) 732-6455

1200 W North Down River Rd
Grayling, MI 49738
Phone (517) 348-2896

Interoperability endpoints

  • Direct secure messaging: kbl@alpineeyecare.ecldirect.net
  • Direct secure messaging: klodewyk649937@direct.vumc.org

Organizations & group practices 3

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 4

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": "1498176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671062400000",
    "number": "1255851952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1665",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497345665",
            "telephone_number": "989-732-6455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 W NORTH ST",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497351525",
            "telephone_number": "989-732-6455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LODEWYK",
        "first_name": "KEVIN",
        "middle_name": "BRADLEY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-23",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301112664",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301506618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "klodewyk@alpineeyecare.direct.medflow.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "350 W North St",
            "city": "Gaylord",
            "state": "MI",
            "country_code": "US",
            "postal_code": "497351525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gaylord, MI

Sources for this page

Verify at the official NPI Registry.