NPIMap

Organization Active NPI

Central Michigan University

  • Sports Medicine (Family Medicine) Physician
  • Mt Pleasant, MI
National Provider Identifier
1447606801
Registry record updated May 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
5101018472 Issued in MI
Legal business name
CENTRAL MICHIGAN UNIVERSITY
Practice address
Cmu Sports Medicine
Rose 100
Mt Pleasant, MI 48859-0001
Phone
(989) 774-2281
Fax
(989) 774-1095
NPI assigned
May 4, 2016
Last updated
May 27, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
1588897896As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 27, 2016

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

Authorized official

Name
Matthew Jackson
Title
Athletic Director
Phone
(989) 774-7657

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X 5101018472 MI Primary

Addresses

Primary practice location

Cmu Sports Medicine
Rose 100
Mt Pleasant, MI 48859-0001

Mailing address

Cmu Sports Medicine
Rose 100
Mt Pleasant, MI 48859-0001
Phone (989) 774-2281

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040416000029 MI Part B Supplier - Clinic/Group Practice 3577558907 Receives reassigned benefits from 21 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Alma, MI; Mt Pleasant, MI

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Student Health Services Phcy

Locations

108 Foust Hall
Mount Pleasant, MI 48859
Phone (989) 774-4367

1101 Health Professions
Mount Pleasant, MI 48859
Phone (989) 774-2597

441 Moore Hall St
Mount Pleasant, MI 48859
Phone (517) 774-3904

Cmu Sports Medicine
Mount Pleasant, MI 48859
Phone (989) 774-2281

Rose 100
Mount Pleasant, MI 48859
Phone (989) 774-2281

1280 E Campus Dr
Ste 2104
Mt Pleasant, MI 48859
Phone (989) 774-6599

195 E Ojibway Ct
Mt Pleasant, MI 48859

2981 Health Pkwy
Ste A
Mt Pleasant, MI 48858
Phone (989) 953-4002

2981 Health Pkwy
Ste B
Mt Pleasant, MI 48858
Phone (989) 667-3420

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1462320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464307200000",
    "number": "1447606801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CMU SPORTS MEDICINE",
            "address_2": "ROSE 100",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488590001",
            "telephone_number": "989-774-2281",
            "fax_number": "989-774-1095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CMU SPORTS MEDICINE",
            "address_2": "ROSE 100",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488590001",
            "telephone_number": "989-774-2281",
            "fax_number": "989-774-1095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MICHIGAN UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "1588897896",
        "enumeration_date": "2016-05-04",
        "last_updated": "2016-05-27",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "ATHLETIC DIRECTOR",
        "authorized_official_telephone_number": "989-774-7657"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MI",
            "license": "5101018472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt Pleasant, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.