NPIMap

Individual provider Active NPI

Kyle David Robertson, D.O.

  • Internal Medicine Physician
  • Warren, MI
National Provider Identifier
1336559004
Registry record updated May 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5101021064 Issued in MI
Practice address
11885 E 12 Mile Rd Ste 300a
Warren, MI 48093-3467
Phone
(586) 582-6630
Fax
(586) 582-6631
NPI assigned
May 5, 2014
Last updated
May 5, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 5, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 5101021064 MI Primary

Addresses

Primary practice location

11885 E 12 Mile Rd Ste 300a
Warren, MI 48093-3467

Mailing address

11885 E 12 Mile Rd Ste 300a
Warren, MI 48093-3467
Phone (586) 582-6630

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200709000565 MI Practitioner - GastroenterologyPractitioner - Internal Medicine 3971806787 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Michigan State University College of Osteopathic Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McLaren Central MichiganGroup PAC ID 6103733092, 183 clinicians

Practice addresses (Care Compare)

1221 S Dr
Mount Pleasant, MI 48858-3257
Phone (989) 772-6811

416 Connable Ave
Petoskey, MI 49770-2212
Phone (800) 248-6777

560 W Mitchell St
Petoskey, MI 49770-2278

560 W Mitchell St
Suite C70
Petoskey, MI 49770-2275
Phone (231) 487-7200

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy109
Upper gastrointestinal (GI) endoscopy for acid reflux221

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
5101021064MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
McLaren Central Michigan Current Accepting new patients
McLaren Central Michigan CurrentSince Sep 1, 2020 Accepting new patients
McLaren Central Michigan CurrentSince Sep 1, 2020 Accepting new patients
Henry Ford Health Macomb-Oakland Hospital Past Accepting new patients
Detroit Macomb-Oakland Hospital Corporation Internal Medicine Past Accepting new patients

Locations

740 S Main St
Cheboygan, MI 49721
Phone (231) 627-4361

1221 South Dr
Mt Pleasant, MI 48858
Phone (989) 772-6700

416 Connable Ave
Petoskey, MI 49770
Phone (231) 487-4000

560 W Mitchell St
Ste M40
Petoskey, MI 49770
Phone (231) 487-2391

Interoperability endpoints

  • Direct secure messaging: krobertson517750@direct.hfhs.org

Organizations & group practices 5

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1399248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399248000000",
    "number": "1336559004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11885 E 12 MILE RD STE 300A",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933467",
            "telephone_number": "586-582-6630",
            "fax_number": "586-582-6631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11885 E 12 MILE RD STE 300A",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933467",
            "telephone_number": "586-582-6630",
            "fax_number": "586-582-6631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "KYLE",
        "middle_name": "DAVID",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-05-05",
        "last_updated": "2014-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101021064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

Verify at the official NPI Registry.