NPIMap

Individual provider Active NPI

Stephan Elliott

  • Family Medicine Physician
  • Midland, MI
National Provider Identifier
1376110643
Registry record updated May 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301511000 Issued in MI
Practice address
4000 Wellness Dr
Midland, MI 48670-2000
Phone
(989) 839-1644
NPI assigned
Jun 7, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X MT222820 PA
Family Medicine Physician 207Q00000X 4301511000 MI Primary

Addresses

Primary practice location

4000 Wellness Dr
Midland, MI 48670-2000

Mailing address

4000 Wellness Dr
Midland, MI 48670-2000

Other practice location 1

555 N Duke St
Lancaster, PA 17602-2250
Phone (717) 544-4940

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
I20240618002213 MI Practitioner - Family Practice 0143621912 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mymichigan Medical Center Alma 140 clinicians
Mymichigan Medical Group 174 clinicians

Practice addresses (Care Compare)

330 E Warwick Dr
Alma, MI 48801-1014
Phone (989) 629-8140

4000 Wellness Dr
Midland, MI 48670-0001
Phone (989) 839-1644

Hospital & facility affiliations

  • Mymichigan Medical Center Alma Hospital, Alma, MI, CCN 230030
  • Mymichigan Medical Center Clare Hospital, Clare, MI, CCN 230180
  • Mymichigan Medical Center Midland Hospital, Midland, MI, CCN 230222

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301511000MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mymichigan Medical Center Alma Family Medicine CurrentSince Jan 24, 2025 Accepting new patients
Mymichigan Medical Center Alpena CurrentSince May 20, 2024 Accepting new patients
Mymichigan Medical Center Alma Current Accepting new patients
Mymichigan Medical Group CurrentSince May 20, 2024 Accepting new patients
Mymichigan Medical Center Sault Family Medicine CurrentSince Jan 27, 2026 Accepting new patients
Mymichigan Medical Group Family Medicine Current Accepting new patients
Mymichigan Medical Center Sault CurrentSince Jan 27, 2026 Accepting new patients
Mymichigan Medical Center Alma Past Accepting new patients

Locations

300 E Warwick Dr
Alma, MI 48801
Phone (989) 463-0104

330 E Warwick Dr
Alma, MI 48801
Phone (989) 466-3330

609 Quarter St
Gladwin, MI 48624
Phone (989) 246-6371

815 N Clare Ave
Harrison, MI 48625
Phone (989) 539-4096

121 N Pine River St
Ithaca, MI 48847
Phone (989) 875-0662

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

500 Osborn Blvd
Sault South Marie, MI 49783
Phone (906) 635-4350

Interoperability endpoints

  • Direct secure messaging: selliott156786@mymichiganhealth.midirect.net

Organizations & group practices 22

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.

View all 22

Hospital & facility affiliations 5

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": "1623024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716163200000",
    "number": "1376110643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 WELLNESS DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486702000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 WELLNESS DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486702000",
            "telephone_number": "989-839-1644"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "555 N Duke St",
            "address_purpose": "LOCATION",
            "city": "Lancaster",
            "state": "PA",
            "postal_code": "176022250",
            "country_code": "US",
            "telephone_number": "717-544-4940",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "STEPHAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-07",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "MT222820",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301511000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, MI

Sources for this page

Verify at the official NPI Registry.