Active NPI
Kenneth Pierce, MD
- Diagnostic Radiology Physician
- Ann Arbor, MI
National Provider Identifier
1417934399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 4301506258
- Practice address
- 2215 Fuller Rd
Ann Arbor, MI 48105-2303 - Phone
- (734) 222-7128
- NPI assigned
- Dec 30, 2005
- 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 |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 4301506258 | MI | Primary |
Addresses
Primary practice location
2215 Fuller Rd
Ann Arbor, MI 48105-2303
Mailing address
2215 Fuller Rd
Ann Arbor, MI 48105-2303
Phone (342) 227-1287
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 36084943 | Medicaid | IL |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301506258 | MI | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chicago Imaging LTD | Diagnostic Radiology | Past | Accepting new patients |
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.
-
- Diagnostic Radiology Physician
- Chicago, IL
- NPI 1114958329
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713312000000",
"number": "1417934399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2215 FULLER RD",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481052303",
"telephone_number": "342-227-1287"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2215 FULLER RD",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481052303",
"telephone_number": "734-222-7128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PIERCE",
"first_name": "KENNETH",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-30",
"last_updated": "2024-04-17",
"certification_date": "2024-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "MI",
"license": "4301506258",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "36084943",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.