Gordon R Bleil, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

056047 Issued in MI

Practice address

955 S Bailey Ave
South Haven, MI 49090-9701

Phone

(269) 639-2910

Fax

(269) 639-2919

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Michigan State University College of Human Medicine, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bronson Lakeview HospitalGroup PAC ID 9032008495, 72 clinicians

Bronson South Haven HospitalGroup PAC ID 6204724834, 38 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bronson South Haven Hospital Hospital, South Haven, MI, CCN 230085
• Bronson Lakeview Hospital Hospital, Paw Paw, MI, CCN 231332

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gbleil30509@direct.bronsonhg.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bronson Lakeview Hospital

  • Internal Medicine Physician
  • Paw Paw, MI
  • NPI 1235131137

  Family Medicine, MI

  Medicare reassignment Care Compare group NPD
• Bronson South Haven Hospital

  • Family Medicine Physician
  • South Haven, MI
  • NPI 1174749170

  Family Medicine, MI

  Medicare reassignment Care Compare group NPD
• Bronson Lakeview Hospital

  • Rural Health Clinic/Center
  • South Haven, MI
  • NPI 1801538871
  NPD
• Bronson South Haven Hospital

  • General Acute Care Hospital
  • South Haven, MI
  • NPI 1346275856
  NPD
• South Haven Family Physicians, P.C.

  • Family Medicine Physician
  • South Haven, MI
  • NPI 1952413403

  Family Medicine

  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bronson Lakeview Hospital

  • Critical Access Hospital
  • Paw Paw, MI
  • NPI 1962508259

  Hospital

  Care Compare affiliation
• Bronson South Haven Hospital

  • General Acute Care Hospital
  • South Haven, MI
  • NPI 1346275856

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479772800000",
    "number": "1295847739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "955 S BAILEY AVE",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490909701",
            "telephone_number": "269-639-2910",
            "fax_number": "269-639-2919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 S BAILEY AVE",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490909701",
            "telephone_number": "269-639-2910",
            "fax_number": "269-639-2919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLEIL",
        "first_name": "GORDON",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2016-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "056047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2937733",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "080064237",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP/IBA",
            "identifier": "0131167",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN",
            "identifier": "P77691",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5976083",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "080H06004",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in South Haven, MI
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.