Brian G. Loder DPM PLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

5901001662 Issued in MI

Legal business name

BRIAN G. LODER DPM PLC

Practice address

43391 Commons Dr
Clinton TWP, MI 48038-1109

Phone

(586) 329-3895

Fax

(586) 329-3916

NPI assigned

Jan 22, 2009

Organization subpart

No

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

Authorized official

Name

Brian George Loder, DPMNPI 1184629180

Title

Owner

Phone

(586) 329-3895

Specialties & licenses 2

Addresses

Other identifiers 5

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 2

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

• Brian George Loder, DPM, CWS

  • Foot & Ankle Surgery Podiatrist
  • Clinton Township, MI
  • NPI 1184629180
  Medicare reassignment Care Compare group NPD Authorized official
• Cody Andrew Brush, DPM

  • Foot & Ankle Surgery Podiatrist
  • Clinton Township, MI
  • NPI 1801259551
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1232582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667347200000",
    "number": "1508004920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15760 19 MILE RD STE E",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480386319",
            "telephone_number": "586-329-3895",
            "fax_number": "586-329-3916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43391 COMMONS DR",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480381109",
            "telephone_number": "586-329-3895",
            "fax_number": "586-329-3916"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15760 19 Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Clinton Twp",
            "state": "MI",
            "postal_code": "480386319",
            "country_code": "US",
            "telephone_number": "586-329-3895",
            "fax_number": "586-329-3916",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BRIAN G. LODER DPM PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-22",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A",
        "authorized_official_last_name": "LODER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "586-329-3895",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MI",
            "license": "5901001662",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "480E027990",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DP6530",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAP",
            "identifier": "U53759",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN GROUP",
            "identifier": "480E027990",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508004920",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "EPIC",
            "affiliation": "Y",
            "endpointDescription": "EPIC",
            "affiliationName": "Henry Ford Macomb Hospital Corporation",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "15760 19 Mile Rd",
            "city": "Clinton Twp",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480386319",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "EPIC",
            "affiliation": "Y",
            "endpointDescription": "EpIC",
            "affiliationName": "Henry Ford Macomb Hospital Corporation",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "43391 Commons Dr",
            "city": "Clinton Twp",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480381109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Timothy Peter Boufford, M.D.
• Brandon R McKenzie DC PLLC
• Anna Brede
• Keith Allen Brennan, D.C.
• Michael Steven Breza, OD
• Brian Hadeed DDS PLLC
• Kevin Alexander Brody, MD
• Katie Brogan
• Candace T Brooks
• Terrina Brown

• Foot & Ankle Surgery Podiatrist in Clinton TWP, MI
• Providers in Clinton TWP, MI by specialty
• Foot & Ankle Surgery Podiatrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 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.