NPIMap

Individual provider Active NPI

Michael Charles Persson Jr., M.D.

  • Family Medicine Physician
  • Davenport, IA
National Provider Identifier
1356485775
Registry record updated May 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
37502 Issued in IA
Practice address
3200 W Kimberly Rd
Davenport, IA 52806-3059
Phone
(563) 421-0100
NPI assigned
Feb 18, 2007
Last updated
May 2, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 37502 IA Primary

Addresses

Primary practice location

3200 W Kimberly Rd
Davenport, IA 52806-3059

Mailing address

3200 W Kimberly Rd
Davenport, IA 52806-3059
Phone (563) 355-9200

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address michael.persson@direct.genesishealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20080303000282 IA Practitioner - Family Practice 6406930304 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Southern Illinois University School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Genesis Health SystemGroup PAC ID 7214841436, 217 clinicians

Practice addresses (Care Compare)

3200 W Kimberly Rd
Davenport, IA 52806-3059
Phone (563) 421-0100

619 5TH St
Durant, IA 52747-7737
Phone (563) 785-4487

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Health System Family Medicine CurrentSince Apr 1, 2012 Accepting new patients
Genesis Health System CurrentSince Apr 1, 2012 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Genesis Health System Family Medicine Past Accepting new patients

Locations

210 W 53rd St
Davenport, IA 52806
Phone (563) 386-3436

1351 W Central Park Ave
Ste 340
Davenport, IA 52804
Phone (563) 421-1287

3200 W Kimberly Rd
Davenport, IA 52806
Phone (563) 421-0010

3618 N Division St
Davenport, IA 52806
Phone (319) 391-4827

1118 11th St
De Witt, IA 52742
Phone (563) 242-7522

619 5th St
Durant, IA 52747
Phone (563) 785-4487

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 4

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": "1171756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619913600000",
    "number": "1356485775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 W KIMBERLY RD",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528063059",
            "telephone_number": "563-355-9200",
            "fax_number": "563-355-3419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 W KIMBERLY RD",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528063059",
            "telephone_number": "563-421-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERSSON",
        "first_name": "MICHAEL",
        "middle_name": "CHARLES",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-18",
        "last_updated": "2021-05-02",
        "certification_date": "2021-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "37502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "michael.persson@direct.genesishealth.com",
            "affiliation": "N",
            "endpointDescription": "genesis health system direct email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "3200 W Kimberly Rd",
            "city": "Davenport",
            "state": "IA",
            "country_code": "US",
            "postal_code": "528063059",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.