Individual provider Active NPI

Rosa Maira

  • Pediatrics Physician
  • Kalamazoo, MI
National Provider Identifier
1487761664
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
5101014172 Issued in MI
Practice address
8088 Vineyard Pkwy
Kalamazoo, MI 49009-3892
Phone
(269) 286-7090
Fax
(269) 286-7091
NPI assigned
Aug 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 5101014172 MI Primary

Addresses

Primary practice location

8088 Vineyard Pkwy
Kalamazoo, MI 49009-3892

Mailing address

5943 Stadium Dr
Suite 3
Kalamazoo, MI 49009-3016

Other practice location 1

4200 S Westnedge Ave
Kalamazoo, MI 49008-3208
Phone (269) 381-3500

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.bronsonhg.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070921000794 MI Practitioner - Pediatric Medicine 5890889745 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Promed Healthcare CurrentSince Dec 1, 2013 Accepting new patients
Ascension Medical Group Promed Pediatrics CurrentSince Dec 1, 2013 Accepting new patients
Bronson Methodist Hospital CurrentSince Jul 1, 2020 Accepting new patients
Ascension Medical Group Promed Pediatrics Current Accepting new patients

Locations

601 John St
Ste M-124
Kalamazoo, MI 49007
Phone (269) 341-7500

1521 Gull Rd
Kalamazoo, MI 49048
Phone (269) 226-5165

5943 Stadium Dr
Ste 3
Kalamazoo, MI 49009
Phone (269) 226-8315

4200 S Westnedge Ave
Kalamazoo, MI 49008
Phone (269) 381-3500

601 John St
Kalamazoo, MI 49007
Phone (269) 341-7100

8088 Vineyard Pkwy
Kalamazoo, MI 49009
Phone (269) 286-7090

8001 Angling Rd
Portage, MI 49024
Phone (269) 321-7200

7901 Angling Rd
Portage, MI 49024
Phone (269) 324-8405

Interoperability endpoints

  • Direct secure messaging: direct@direct.bronsonhg.org

Organizations & group practices 4

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": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1487761664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5943 STADIUM DR",
            "address_2": "SUITE 3",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490093016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8088 VINEYARD PKWY",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490093892",
            "telephone_number": "269-286-7090",
            "fax_number": "269-286-7091"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4200 S Westnedge Ave",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490083208",
            "country_code": "US",
            "telephone_number": "269-381-3500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAIRA",
        "first_name": "ROSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-24",
        "last_updated": "2023-11-27",
        "certification_date": "2020-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "5101014172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson HealthCare Group Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.