NPIMap

Organization Active NPI

Eugene P Wang, DO PC

  • Physical Medicine & Rehabilitation Physician
  • Petoskey, MI
National Provider Identifier
1457544017
Registry record updated Sep 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
077046 Issued in MI
Legal business name
EUGENE P WANG, DO PC
Practice address
2375 Summit Park Dr
Petoskey, MI 49770-8685
Phone
(231) 348-3283
Fax
(231) 348-3331
NPI assigned
Aug 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2022

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

Authorized official

Name
Shelly Genschaw
Title
Practice Administrator
Phone
(231) 348-3283

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X 077046 MI Primary

Addresses

Primary practice location

2375 Summit Park Dr
Petoskey, MI 49770-8685

Mailing address

2375 Summit Park Drive
Petoskey, MI 49770
Phone (231) 348-3283

Other practice location 1

2922 D and M Dr Ste B
Gaylord, MI 49735-7417
Phone (231) 348-3283

Other names 1

  • Harborside Spine & Sports Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071012000124 MI Part B Supplier - Clinic/Group Practice 5294821807 Receives reassigned benefits from 6 practitioners
Practice locations: Petoskey, MI; Gaylord, MI

National Provider Directory

National Provider Directory

Locations

948 N Center Ave
Gaylord, MI 49735
Phone (989) 448-2004

2922 D and M Dr
Ste B
Gaylord, MI 49735
Phone (231) 348-3283

4048 Cedar Bluff Dr
Ste 3
Petoskey, MI 49770
Phone (231) 348-3283

2375 Summit Park Dr
Petoskey, MI 49770
Phone (231) 348-3283

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1188172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663632000000",
    "number": "1457544017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2375 SUMMIT PARK DRIVE",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "49770",
            "telephone_number": "231-348-3283",
            "fax_number": "231-348-3331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2375 SUMMIT PARK DR",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708685",
            "telephone_number": "231-348-3283",
            "fax_number": "231-348-3331"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2922 D and M Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "Gaylord",
            "state": "MI",
            "postal_code": "497357417",
            "country_code": "US",
            "telephone_number": "231-348-3283",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EUGENE P WANG, DO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-27",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A",
        "authorized_official_last_name": "GENSCHAW",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "231-348-3283"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "077046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harborside Spine & Sports Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Harborside Spine & Sports Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Petoskey, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; 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.