Active NPI
Richard Wayne Siders, MD
- Diagnostic Radiology Physician
- Sault Ste Marie, MI
National Provider Identifier
1477630432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 4301029531
- Practice address
- 500 Osborn Blvd
Sault Ste Marie, MI 49783 - Phone
- (906) 635-4438
- Fax
- (906) 635-4467
- NPI assigned
- Nov 1, 2006
- Last updated
- Oct 3, 2007
- 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 | 4301029531 | MI | Primary |
Addresses
Primary practice location
500 Osborn Blvd
Sault Ste Marie, MI 49783
Mailing address
PO Box 1108
Attn Barb Simmons
Ann Arbor, MI 48106-1108
Phone (734) 677-7400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4920637 | Medicaid | MI |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Consulting Radiologists Corporation | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Diagnostic Radiology Physician
- Toledo, OH
- NPI 1104919000
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191369600000",
"number": "1477630432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1108",
"address_2": "ATTN BARB SIMMONS",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481061108",
"telephone_number": "734-677-7400",
"fax_number": "734-677-1603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 OSBORN BLVD",
"city": "SAULT STE MARIE",
"state": "MI",
"postal_code": "49783",
"telephone_number": "906-635-4438",
"fax_number": "906-635-4467"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIDERS",
"first_name": "RICHARD",
"middle_name": "WAYNE",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2007-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "MI",
"license": "4301029531",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4920637",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sault Ste Marie, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.