Organization Active NPI

Compassionate Gynecology of Michigan PLLC

  • Gynecology Physician
  • Fenton, MI
National Provider Identifier
1295479251
Registry record updated Apr 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
Legal business name
COMPASSIONATE GYNECOLOGY OF MICHIGAN PLLC
Practice address
445 N Fenway Dr
Fenton, MI 48430-2666
Phone
(810) 869-6086
Fax
(833) 872-0085
NPI assigned
Apr 26, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2023

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

Authorized official

Name
Martinique Kling, MDNPI 1831399021
Title
Owner
Phone
(989) 430-8964

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207VG0400X Primary
Clinic/Center 261Q00000X

Addresses

Primary practice location

445 N Fenway Dr
Fenton, MI 48430-2666

Mailing address

445 N Fenway Dr
Fenton, MI 48430-2666
Phone (810) 869-6086

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230127000900 MI Part B Supplier - Clinic/Group Practice 3678944725 Receives reassigned benefits from 1 practitioner
Practice locations: Fenton, MI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2262570Compassionate Gynecology of Michigan445 N Fenway Drive, Fenton, MI 48430Certificate of waiverJun 14, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1650931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681776000000",
    "number": "1295479251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 N FENWAY DR",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484302666",
            "telephone_number": "810-869-6086",
            "fax_number": "833-872-0085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 N FENWAY DR",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484302666",
            "telephone_number": "810-869-6086",
            "fax_number": "833-872-0085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPASSIONATE GYNECOLOGY OF MICHIGAN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-26",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A",
        "authorized_official_last_name": "KLING",
        "authorized_official_first_name": "MARTINIQUE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-430-8964",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fenton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.