Active NPI
Peter Bistolarides, MD
- Surgery Physician
- Midland, MI
National Provider Identifier
1407838048
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 4301064856
- Practice address
- 4201 Campus Ridge Drive
Midland, MI 48640 - Phone
- (989) 839-1795
- Fax
- (989) 839-1785
- NPI assigned
- Nov 18, 2005
- Last updated
- Nov 3, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 4301064856 | MI | Primary |
Addresses
Primary practice location
4201 Campus Ridge Drive
Midland, MI 48640
Mailing address
4201 Campus Ridge Drive
Midland, MI 48640
Phone (989) 839-1795
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 156543 | Other | GREAT LAKES HEALTH PLAN | |
| 020G361410 | Other | MI | BCBSM GROUP PIN |
| 0993608 | Other | HEALTHPLUS OF MICHIGAN | |
| P00348487 | Other | RAILROAD MEDICARE | |
| 104905069 | Medicaid | MI | |
| PB064856 | Other | MI | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478131200000",
"number": "1407838048",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4201 CAMPUS RIDGE DRIVE",
"city": "MIDLAND",
"state": "MI",
"postal_code": "48640",
"telephone_number": "989-839-1795",
"fax_number": "989-839-1785"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4201 CAMPUS RIDGE DRIVE",
"city": "MIDLAND",
"state": "MI",
"postal_code": "48640",
"telephone_number": "989-839-1795",
"fax_number": "989-839-1785"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BISTOLARIDES",
"first_name": "PETER",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-18",
"last_updated": "2016-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MI",
"license": "4301064856",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GREAT LAKES HEALTH PLAN",
"identifier": "156543",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM GROUP PIN",
"identifier": "020G361410",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPLUS OF MICHIGAN",
"identifier": "0993608",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00348487",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "104905069",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "PB064856",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Midland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.