Individual provider Active NPI

Michael Bartholomew Kraemer, DMD, MD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Warren, MI
National Provider Identifier
1366480238
Registry record updated Aug 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
2901016237 Issued in MI
Practice address
29427 Ryan Rd
Warren, MI 48092-2203
Phone
(586) 755-9340
Fax
(586) 755-1081
NPI assigned
Jun 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 2901017657 MI
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X 2901016237 MI Primary

Addresses

Primary practice location

29427 Ryan Rd
Warren, MI 48092-2203

Mailing address

29425 Ryan Rd
Warren, MI 48092-2203
Phone (586) 755-9340

Other identifiers 2

IdentifierTypeStateIssuer
0205016472OtherMIBC MED/SURG PIN
970E07680OtherMIBLUE CROSS PIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050825000444 MI Practitioner - Maxillofacial SurgeryPractitioner - Oral Surgery 8022049410 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Maxillofacial SurgeryAlso: Oral Surgery
Education
Tufts University School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Oral and Maxillofacial Surgery PCGroup PAC ID 5991772287, 7 clinicians

Practice addresses (Care Compare)

29427 Ryan Rd
Warren, MI 48092-2203
Phone (586) 755-9340

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2901016237MIMDOral & Maxillofacial Surgery (D.M.D.)

Interoperability endpoints

  • Direct secure messaging: mkraemer1135192@direct.hfhs.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439164800000",
    "number": "1366480238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29425 RYAN RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480922203",
            "telephone_number": "586-755-9340",
            "fax_number": "586-755-9341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29427 RYAN RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480922203",
            "telephone_number": "586-755-9340",
            "fax_number": "586-755-1081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRAEMER",
        "first_name": "MICHAEL",
        "middle_name": "BARTHOLOMEW",
        "name_prefix": "Dr.",
        "credential": "DMD, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2015-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "2901017657",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MI",
            "license": "2901016237",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC MED/SURG PIN",
            "identifier": "0205016472",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PIN",
            "identifier": "970E07680",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

Verify at the official NPI Registry.