Active NPI
Gregory J Fortin, M.D.
- Vascular Surgery Physician
- Flint, MI
National Provider Identifier
1295707487
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Surgery Physician
- License
- GF048390
- Practice address
- 5020 W Bristol Rd
Flint, MI 48507-2919 - Phone
- (810) 732-1620
- Fax
- (810) 732-8559
- NPI assigned
- Feb 2, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Vascular Surgery Physician | 2086S0129X | GF048390 | MI | Primary |
Addresses
Primary practice location
5020 W Bristol Rd
Flint, MI 48507-2919
Mailing address
5020 W Bristol Rd
Flint, MI 48507-2919
Phone (810) 732-1620
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0210222032 | Other | MI | HEALTHPLUS OF MICHIGAN |
| 204107 | Other | MI | MCLAREN HEALTH PLAN/ADVAN |
| B63761 | Other | MI | HEALTH ALLIANCE PLAN |
| 382237803112 | Other | MI | COMMUNITY CHOICE |
| 4294605 | Other | MI | AETNA |
| 105381 | Other | MI | PREFERRED CHOICE PPO |
| 105381 | Other | MI | CARE CHOICE HMO |
| 109241 | Other | ME | GREAT LAKES HEALTH PLAN |
| 2607980 | Medicaid | MI | |
| 0202532841 | Other | MI | BC/BS OF MICHIGAN |
| C1986 | Other | MI | M-CARE |
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| GF048390 | MI | MD | Vascular Surgery Physician |
Interoperability endpoints
- gregoryfortin@mvc.allscriptsdirect.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196121600000",
"number": "1295707487",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5020 W BRISTOL RD",
"city": "FLINT",
"state": "MI",
"postal_code": "485072919",
"telephone_number": "810-732-1620",
"fax_number": "810-732-8559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5020 W BRISTOL RD",
"city": "FLINT",
"state": "MI",
"postal_code": "485072919",
"telephone_number": "810-732-1620",
"fax_number": "810-732-8559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORTIN",
"first_name": "GREGORY",
"middle_name": "J",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-02",
"last_updated": "2007-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "MI",
"license": "GF048390",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPLUS OF MICHIGAN",
"identifier": "0210222032",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCLAREN HEALTH PLAN/ADVAN",
"identifier": "204107",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE PLAN",
"identifier": "B63761",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMUNITY CHOICE",
"identifier": "382237803112",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4294605",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED CHOICE PPO",
"identifier": "105381",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARE CHOICE HMO",
"identifier": "105381",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GREAT LAKES HEALTH PLAN",
"identifier": "109241",
"state": "ME"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2607980",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS OF MICHIGAN",
"identifier": "0202532841",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "M-CARE",
"identifier": "C1986",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flint, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.