Richard Lee Mogerman, MD

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

4301045763 Issued in MI

Practice address

9991 Cooper Creek Rd
Free Soil, MI 49411-9717

Phone

(231) 723-0752

NPI assigned

Aug 31, 2006

Reactivated

Apr 7, 2021

Sex

Male

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1265544308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9991 COOPER CREEK RD",
            "city": "FREE SOIL",
            "state": "MI",
            "postal_code": "494119717",
            "telephone_number": "231-723-0752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9991 COOPER CREEK RD",
            "city": "FREE SOIL",
            "state": "MI",
            "postal_code": "494119717",
            "telephone_number": "231-723-0752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOGERMAN",
        "first_name": "RICHARD",
        "middle_name": "LEE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "deactivation_date": "2017-03-08",
        "reactivation_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MI",
            "license": "4301045763",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2869366",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0535763",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carol E. Peterson, MD PLC
• Shelby Fricke
• Katelyn Graczyk
• Susan K Henry, MD
• Amanda Nasor
• West Mi. Regional Cancer and Blood Center
• Paula Kathleen Wietrzykowski, L.M.S.W.

• Orthopaedic Surgery Physician in Free Soil, MI
• Providers in Free Soil, MI by specialty
• Orthopaedic Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.