NPIMap

Individual provider Active NPI

Michael A Ziccardi Jr., DO

  • Family Medicine Physician
  • Fenton, MI
National Provider Identifier
1366433377
Registry record updated Oct 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101012293 Issued in MI
Practice address
2420 Owen Rd
Fenton, MI 48430-3417
Phone
(810) 496-2500
Fax
(810) 629-0415
NPI assigned
Oct 31, 2005
Last updated
Oct 16, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2012

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 5101012293 MI Primary

Addresses

Primary practice location

2420 Owen Rd
Fenton, MI 48430-3417

Mailing address

401 S Ballenger Hwy
Flint, MI 48532-3638
Phone (810) 342-1000

Other identifiers 15

IdentifierTypeStateIssuer
C7899OtherMIMCARE
G56808OtherMIHEALTH ALLIANCE PLAN
080D410020OtherMIBLUE CROSS POS
5639565OtherMIAETNA
080D410020OtherMIBLUE CROSS BLUE SHIELD
253396OtherMIHEALTH ADVANTAGE NETWORK
9921034004OtherMICIGNA
080D410020OtherMICOMMUNITY BLUE
0852502204OtherMIBLUE CROSS BLUE SHIELD
0990939OtherMIHEALTH PLUS
253396OtherMIMCLAREN HEALTH PLAN
G56808OtherMIHEALTH NET FEDERAL SERV
080172343OtherMIMETRAHEALTH
080D410020OtherMIBLUE CARE NETWORK
4361486MedicaidMI

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
I20091203000354 MI Practitioner - Family Practice 0143369272 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McLaren FlintGroup PAC ID 8628975497, 144 clinicians

Practice addresses (Care Compare)

2420 Owen Rd
Suite a
Fenton, MI 48430-3417
Phone (810) 496-2500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101012293MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
McLaren Flint Family Medicine CurrentSince Apr 1, 2012 Accepting new patients
McLaren Flint CurrentSince Apr 1, 2012 Accepting new patients
McLaren Flint Current Accepting new patients
McLaren Health Management Group PastSince Jan 31, 2020 Accepting new patients

Locations

2420 Owen Rd
Ste A
Fenton, MI 48430
Phone (810) 496-2460

401 S Ballenger Hwy
Flint, MI 48532
Phone (810) 342-1000

Ownership & related parties

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
McLaren Home HealthLansing, MI, CCN 237008 Home health agency Corporate Director Jan 31, 2020
McLaren Home HealthDavison, MI, CCN 237010 Home health agency Corporate Director Jan 31, 2020
McLaren Home HealthBay City, MI, CCN 237165 Home health agency Corporate Director Jan 31, 2020
McLaren Home HealthClinton Township, MI, CCN 237172 Home health agency Corporate Director Jan 31, 2020
McLaren Home HealthMt. Pleasant, MI, CCN 237036 Home health agency Corporate Director Jan 31, 2020
McLaren Home HealthCheboygan, MI, CCN 237160 Home health agency Corporate Director Oct 1, 2020
McLaren HospiceDavison, MI, CCN 231521 Hospice Corporate Director Jan 31, 2020
McLaren HospicePetoskey, MI, CCN 231541 Hospice Operational/Managerial Control Oct 1, 2020

Owned or controlled facilities with NPI records 8

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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 1

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": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350345600000",
    "number": "1366433377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 S BALLENGER HWY",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323638",
            "telephone_number": "810-342-1000",
            "fax_number": "810-342-1590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2420 OWEN RD",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484303417",
            "telephone_number": "810-496-2500",
            "fax_number": "810-629-0415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZICCARDI",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-31",
        "last_updated": "2012-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101012293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE",
            "identifier": "C7899",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE PLAN",
            "identifier": "G56808",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS POS",
            "identifier": "080D410020",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5639565",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "080D410020",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ADVANTAGE NETWORK",
            "identifier": "253396",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "9921034004",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY BLUE",
            "identifier": "080D410020",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0852502204",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLUS",
            "identifier": "0990939",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCLAREN HEALTH PLAN",
            "identifier": "253396",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET FEDERAL SERV",
            "identifier": "G56808",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "METRAHEALTH",
            "identifier": "080172343",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "080D410020",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4361486",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fenton, MI

Sources for this page

Verify at the official NPI Registry.