Individual provider Active NPI

Erik T Hudak, D.C.

  • Chiropractor
  • Saint Joseph, MI
National Provider Identifier
1487603288
Registry record updated Jul 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301008692 Issued in MI
Practice address
804 Elm St
Saint Joseph, MI 49085-1227
Phone
(269) 983-5527
Fax
(269) 983-3610
NPI assigned
May 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2301008692 MI Primary

Addresses

Primary practice location

804 Elm St
Saint Joseph, MI 49085-1227

Mailing address

804 Elm St
Saint Joseph, MI 49085-1227
Phone (269) 983-5527

Other identifiers 4

IdentifierTypeStateIssuer
07589461OtherMIAETNA
EH008692OtherMIBCBS OF MI LICENSE
200520244053OtherMICOMMUNITY CHOICE
44 30219OtherMIPHYSICIANS HEALTH PLAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040507000044 MI Practitioner - Chiropractic 9234127556 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - West Sunnyvale, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hudak Chiropractic Clinic PCGroup PAC ID 2264420579, 2 clinicians

Practice addresses (Care Compare)

804 Elm St
St Joseph, MI 49085-1227
Phone (269) 983-5527

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2301008692MIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Hudak Chiropractic Clinic, PC Chiropractor CurrentSince Jan 1, 2004 Accepting new patients

Locations

804 Elm St
Saint Joseph, MI 49085
Phone (269) 983-5527

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.

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185148800000",
    "number": "1487603288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 ELM ST",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490851227",
            "telephone_number": "269-983-5527",
            "fax_number": "269-983-3610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 ELM ST",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490851227",
            "telephone_number": "269-983-5527",
            "fax_number": "269-983-3610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDAK",
        "first_name": "ERIK",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-09",
        "last_updated": "2007-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301008692",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "07589461",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MI LICENSE",
            "identifier": "EH008692",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY CHOICE",
            "identifier": "200520244053",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIANS HEALTH PLAN",
            "identifier": "44 30219",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.