NPIMap

Organization Active NPI

Michigan State University

  • Neonatal-Perinatal Medicine Physician
  • Lansing, MI
National Provider Identifier
1467535211
Registry record updated Feb 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
Legal business name
MICHIGAN STATE UNIVERSITY
Practice address
1215 E Michigan Ave
Sparrow Hospital - Neonatology Unit
Lansing, MI 48912-1811
Phone
(517) 364-2670
Fax
(517) 364-3994
NPI assigned
Oct 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2018

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

Authorized official

Name
Mrs. Lisa M Rucker
Title
Provider Enrollment Manager
Phone
(517) 355-8462

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080N0001X Primary

Addresses

Primary practice location

1215 E Michigan Ave
Sparrow Hospital - Neonatology Unit
Lansing, MI 48912-1811

Mailing address

804 Service Rd
Room A201
East Lansing, MI 48824-7015
Phone (517) 884-2976

Other identifiers 1

IdentifierTypeStateIssuer
3043440MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031106000079 MI Part B Supplier - Clinic/Group Practice 3870405954 Receives reassigned benefits from 52 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Haslett, MI; East Lansing, MI; Lansing, MI; Grand Rapids, MI; Eaton Rapids, MI; Charlotte, MI

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

Locations

804 Service Rd
Rm A201
East Lansing, MI 48824

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": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518048000000",
    "number": "1467535211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 SERVICE RD",
            "address_2": "ROOM A201",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247015",
            "telephone_number": "517-884-2976",
            "fax_number": "517-432-3928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 E MICHIGAN AVE",
            "address_2": "SPARROW HOSPITAL - NEONATOLOGY UNIT",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489121811",
            "telephone_number": "517-364-2670",
            "fax_number": "517-364-3994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2018-02-08",
        "status": "A",
        "authorized_official_last_name": "RUCKER",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "517-355-8462",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3043440",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lansing, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2018; 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.