NPIMap

Organization Active NPI

Eastern Michigan University

  • Health Maintenance Organization
  • Ypsilanti, MI
National Provider Identifier
1346628534
Registry record updated May 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
License
3667518 Issued in MI
Legal business name
EASTERN MICHIGAN UNIVERSITY
Practice address
799 N Hewitt Rd
Ypsilanti, MI 48197-1701
Phone
(734) 487-5179
NPI assigned
May 8, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2015

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

Authorized official

Name
Nikolis Gustafson, ATC
Title
Athletic Trainer
Phone
(612) 242-2676

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X 3667518 MI Primary

Addresses

Primary practice location

799 N Hewitt Rd
Ypsilanti, MI 48197-1701

Mailing address

PO Box 446
Lester Prairie, MN 55354-0446

National Provider Directory

National Provider Directory
Tax ID family
Eastern Michigan University7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

799 N Hewitt Rd
Ypsilanti, MI 48197
Phone (734) 487-5179

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1431043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431043200000",
    "number": "1346628534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 446",
            "city": "LESTER PRAIRIE",
            "state": "MN",
            "postal_code": "553540446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "799 N HEWITT RD",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971701",
            "telephone_number": "734-487-5179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN MICHIGAN UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-08",
        "last_updated": "2015-05-08",
        "status": "A",
        "authorized_official_last_name": "GUSTAFSON",
        "authorized_official_first_name": "NIKOLIS",
        "authorized_official_title_or_position": "ATHLETIC TRAINER",
        "authorized_official_telephone_number": "612-242-2676",
        "authorized_official_credential": "ATC"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "MI",
            "license": "3667518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ypsilanti, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.