Stuart Etengoff, DO

Primary specialty

Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X

License

5101009547 Issued in MI

Practice address

1 Genesys Pkwy
Grand Blanc, MI 48439-8065

Phone

(810) 606-6137

NPI assigned

Nov 23, 2005

Last updated

Mar 6, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 5

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

Emergency Medicine

Education

New York College of Osteo Medicine of New York Institute of Technology, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

McLaren Hospital GroupGroup PAC ID 2365968351, 366 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• McLaren Oakland Hospital, Pontiac, MI, CCN 230207

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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

• McLaren Hospital Group

  • Emergency Medicine Physician
  • Flint, MI
  • NPI 1942026174
  Medicare reassignment Care Compare group NPD
• Degara App, PLLC

  • Emergency Medicine Physician
  • Lansing, MI
  • NPI 1265976971
  Medicare reassignment NPD
• Springfield Urgent Care, P.L.L.C.

  • Urgent Care Clinic/Center
  • Clarkston, MI
  • NPI 1144747460
  Medicare reassignment NPD
• Emergency Medicine Physicians of Genesee County, PLLC

  • Emergency Medicine Physician
  • Grand Blanc, MI
  • NPI 1275899171
  NPD (past)
• Obscare PC

  • Emergency Medicine Physician
  • Grand Blanc, MI
  • NPI 1255361598
  NPD (past)
• Stat Care PC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Flint, MI
  • NPI 1013919372
  NPD (past)
• Statcare PC

  • Emergency Medicine Physician
  • Grand Blanc, MI
  • NPI 1255333498
  NPD (past)

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

• McLaren Oakland

  • General Acute Care Hospital
  • Pontiac, MI
  • NPI 1376564088
  Care Compare affiliation

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

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204761600000",
    "number": "1326021213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT CH 17767",
            "city": "PALATINE",
            "state": "IL",
            "postal_code": "600550001",
            "telephone_number": "800-968-6866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GENESYS PKWY",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484398065",
            "telephone_number": "810-606-6137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETENGOFF",
        "first_name": "STUART",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-23",
        "last_updated": "2008-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101009547",
            "primary": false
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "MI",
            "license": "5101009547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3095035",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3483706",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "SE009547",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3483804",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00113859",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Emergency Medical Services (Emergency Medicine) Physician in Grand Blanc, MI
• Providers in Grand Blanc, MI by specialty
• Emergency Medical Services (Emergency Medicine) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2008; 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.