NPIMap

Individual provider Active NPI

Ed Adel Itawi, MD

  • Colon & Rectal Surgery Physician
  • Kalamazoo, MI
National Provider Identifier
1366645574
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
4301084241 Issued in MI
Practice address
601 John St
Suite M302
Kalamazoo, MI 49007-5341
Phone
(269) 341-4890
Fax
(269) 341-4889
NPI assigned
Jun 6, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 4301084241 MI
Student in an Organized Health Care Education/Training Program 390200000X 4301084241 MI
Colon & Rectal Surgery Physician 208C00000X 4301084241 MI Primary

Addresses

Primary practice location

601 John St
Suite M302
Kalamazoo, MI 49007-5341

Mailing address

601 John St
Suite M302
Kalamazoo, MI 49007-5341
Phone (269) 341-4890

Other identifiers 2

IdentifierTypeStateIssuer
1366645574MedicaidMI
1417961137OtherMIBCBS - BRONSON

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.bronsonhg.org Direct

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
I20101026000345 MI Practitioner - Colorectal Surgery (Proctology) 4486847191 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Colorectal Surgery (Proctology)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Acute Care Surgeons PCGroup PAC ID 6002956265, 15 clinicians
Bronson Methodist HospitalGroup PAC ID 0244148633, 721 clinicians

Practice addresses (Care Compare)

22101 Moross Rd
Detroit, MI 48236-2148
Phone (313) 343-4000

47601 Grand River Ave
Novi, MI 48374-1233
Phone (248) 465-4100

601 John St
Suite 302
Kalamazoo, MI 49007-5357
Phone (269) 341-4890

Hospital & facility affiliations

  • Bronson Methodist Hospital Hospital, Kalamazoo, MI, CCN 230017
  • Bronson Lakeview Hospital Hospital, Paw Paw, MI, CCN 231332
  • Ascension Providence Hospital, Southfield and Novi Hospital, Southfield, MI, CCN 230019
  • Bronson Battle Creek Hospital Hospital, Battle Creek, MI, CCN 230075

Merit-based Incentive Payment System (MIPS)

Final score
86.43 of 100Reported as group
Quality
75.38
Promoting interoperability
100
Improvement activities
40
Cost
79.38

Merit-based Incentive Payment System (MIPS)

Final score
93.89 of 100Reported as group
Quality
95.63
Promoting interoperability
100
Improvement activities
40
Cost
84

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy88
Melanoma (skin cancer) excision1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301084241MIMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Bronson Methodist Hospital CurrentSince May 1, 2012 Accepting new patients
Henry Ford Health Providence Hospital Surgery CurrentSince Nov 3, 2013 Accepting new patients
Bronson Lakeview Hospital Surgery CurrentSince Jan 5, 2019 Accepting new patients
Bronson Lakeview Hospital CurrentSince Jan 5, 2019 Accepting new patients
Bronson Lakeview Hospital Current Accepting new patients
Henry Ford Health Providence Hospital CurrentSince Nov 3, 2013 Accepting new patients
Critical Care Surgeons PLLC Past Accepting new patients
Bronson Methodist Hospital Past Accepting new patients

Locations

601 John St
Ste M-302
Kalamazoo, MI 49007
Phone (269) 276-0000

601 John St
Kalamazoo, MI 49007
Phone (269) 341-7100

601 John St
Ste M-124
Kalamazoo, MI 49007
Phone (269) 341-7500

47601 Grand River Ave
Novi, MI 48374
Phone (248) 465-4100

451 Health Pkwy
Paw Paw, MI 49079
Phone (269) 655-1725

408 Hazen St
Paw Paw, MI 49079
Phone (269) 341-8481

16001 W 9 Mile Rd
Southfield, MI 48075
Phone (248) 424-3000

Interoperability endpoints

  • Direct secure messaging: direct@direct.bronsonhg.org
  • Direct secure messaging: eitawi1132992@direct.hfhs.org

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 and National Provider Directory roles.

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": "1181088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1366645574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 JOHN ST",
            "address_2": "SUITE M302",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075341",
            "telephone_number": "269-341-4890",
            "fax_number": "269-341-4889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 JOHN ST",
            "address_2": "SUITE M302",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075341",
            "telephone_number": "269-341-4890",
            "fax_number": "269-341-4889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ITAWI",
        "first_name": "ED",
        "middle_name": "ADEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-06",
        "last_updated": "2023-11-27",
        "certification_date": "2020-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301084241",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4301084241",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "MI",
            "license": "4301084241",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366645574",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - BRONSON",
            "identifier": "1417961137",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson Healthcare Group Direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.