NPIMap

Organization Active NPI

Northeastern Michigan Cancer Center

  • Radiation Oncology Physician
  • Alpena, MI
National Provider Identifier
1275567869
Registry record updated Oct 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
NORTHEASTERN MICHIGAN CANCER CENTER
Practice address
1501 West Chisholm St
Alpena, MI 49707
Phone
(989) 356-7597
NPI assigned
Jul 10, 2006
Last updated
Oct 8, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2015

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

Authorized official

Name
George Smart
Title
VP
Phone
(989) 356-7597

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X NU Primary

Addresses

Primary practice location

1501 West Chisholm St
Alpena, MI 49707

Mailing address

1501 W Chisholm Street
Alpena, MI 49707
Phone (989) 356-7597

Other identifiers 1

IdentifierTypeStateIssuer
320Z410160OtherMIBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040417000515 MI Part B Supplier - Clinic/Group Practice 0840285904 Receives reassigned benefits from 29 practitioners
1 other NPI on this enrollment
Practice locations: Alpena, MI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Northeastern Michigan Cancer Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444262400000",
    "number": "1275567869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 W CHISHOLM STREET",
            "city": "ALPENA",
            "state": "MI",
            "postal_code": "49707",
            "telephone_number": "989-356-7597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 WEST CHISHOLM ST",
            "city": "ALPENA",
            "state": "MI",
            "postal_code": "49707",
            "telephone_number": "989-356-7597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEASTERN MICHIGAN CANCER CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2015-10-08",
        "status": "A",
        "authorized_official_last_name": "SMART",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "989-356-7597"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "320Z410160",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alpena, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.