NPIMap

Individual provider Active NPI

Kelly Rose Menge, D.O.

  • Obstetrics & Gynecology Physician
  • Ishpeming, MI
National Provider Identifier
1356546378
Registry record updated May 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
5101017173 Issued in MI
Practice address
901 Lakeshore Dr.
Ishpeming, MI 49849
Phone
(906) 485-2665
Fax
(906) 485-2731
NPI assigned
Jun 19, 2007
Last updated
May 12, 2014By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 12, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 5101017173 MI Primary

Addresses

Primary practice location

901 Lakeshore Dr.
Ishpeming, MI 49849

Mailing address

901 Lakeshore Dr
Ishpeming, MI 49849
Phone (906) 485-2665

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
I20110922000486 MI Practitioner - Obstetrics/GynecologyPractitioner - Preventive Medicine 2062683014 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/GynecologyAlso: Preventive Medicine
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baraga County Memorial HospitalGroup PAC ID 7416866611, shared by 6 NPIs, 17 clinicians
St Francis HospitalGroup PAC ID 5991604753, 85 clinicians

Practice addresses (Care Compare)

18341 US Hwy 41
Lanse, MI 49946-8024
Phone (906) 524-3320

3409 Ludington St
Escanaba, MI 49829-4213

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101017173MIMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bell Physician Practices Inc CurrentSince Dec 1, 2013 Accepting new patients
Bell Physician Practices Inc Obstetrics & Gynecology CurrentSince Dec 1, 2013 Accepting new patients
St. Francis Hospital CurrentSince Sep 1, 2024 Accepting new patients
St. Francis Hospital Obstetrics & Gynecology Current Accepting new patients
St Francis Hospital CurrentSince Sep 1, 2024 Accepting new patients
Bell Medical Center PastSince Apr 30, 2013 Accepting new patients
St Francis Hospital Past Accepting new patients

Locations

3409 Ludington St
Ste 104
Escanaba, MI 49829
Phone (906) 786-8343

3409 Ludington St
Ste 204
Escanaba, MI 49829
Phone (906) 736-1356

901 Lakeshore Dr
Ishpeming, MI 49849
Phone (906) 485-2653

Organizations & group practices 9

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 3

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": "1182211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399852800000",
    "number": "1356546378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 LAKESHORE DR",
            "city": "ISHPEMING",
            "state": "MI",
            "postal_code": "49849",
            "telephone_number": "906-485-2665",
            "fax_number": "906-485-2731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 LAKESHORE DR.",
            "city": "ISHPEMING",
            "state": "MI",
            "postal_code": "49849",
            "telephone_number": "906-485-2665",
            "fax_number": "906-485-2731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENGE",
        "first_name": "KELLY",
        "middle_name": "ROSE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-19",
        "last_updated": "2014-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "5101017173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ishpeming, MI

Sources for this page

Verify at the official NPI Registry.