Active NPI
McLaren Medical Group
- Pediatrics Physician
- Lapeer, MI
National Provider Identifier
1306983176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- Legal business name
- MCLAREN MEDICAL GROUP
- Practice address
- 1254 N Main St
Lapeer, MI 48446-1343 - Phone
- (810) 664-4531
- Fax
- (810) 337-7337
- NPI assigned
- Jan 31, 2007
- Last updated
- Feb 12, 2016
- Organization subpart
- Yes
- Parent organization
- MCLAREN MEDICAL MANAGEMENT INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. William Hardimon
- Title
- Ceo
- Phone
- (810) 342-1040
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | Primary |
Addresses
Primary practice location
1254 N Main St
Lapeer, MI 48446-1343
Mailing address
401 S Ballenger Hwy
Flint, MI 48532-3638
Phone (810) 342-1000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 350D410030 | Other | MI | BLUE CROSS BLUE SHIELD |
Other names 1
- McLaren Medical Managment, Inc.
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031106000025 | MI | Part B Supplier - Clinic/Group Practice | 3971416082 |
Receives reassigned benefits from 458 practitioners 8 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
Other NPIs on the same Medicare enrollment 8
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Part of
- McLaren Services Corpor
Practitioners & affiliated clinicians
Practitioners 4
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.
-
- Pediatrics Physician
- Lapeer, MI
- NPI 1962484139
-
- Pediatrics Physician
- Fenton, MI
- NPI 1982694238
-
- Pediatrics Physician
- Lapeer, MI
- NPI 1508857822
-
- Pediatrics Physician
- Okemos, MI
- NPI 1194866046
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1455235200000",
"number": "1306983176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 S BALLENGER HWY",
"city": "FLINT",
"state": "MI",
"postal_code": "485323638",
"telephone_number": "810-342-1000",
"fax_number": "810-342-1590"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1254 N MAIN ST",
"city": "LAPEER",
"state": "MI",
"postal_code": "484461343",
"telephone_number": "810-664-4531",
"fax_number": "810-337-7337"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MCLAREN MEDICAL GROUP",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MCLAREN MEDICAL MANAGEMENT INC",
"enumeration_date": "2007-01-31",
"last_updated": "2016-02-12",
"status": "A",
"authorized_official_last_name": "HARDIMON",
"authorized_official_first_name": "WILLIAM",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "810-342-1040",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Pediatrics",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "350D410030",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "McLaren Medical Managment, Inc.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Lapeer, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2016; 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.