NPIMap

Individual provider Active NPI

Sean E Theisen, M.D.

  • Diagnostic Radiology Physician
  • Ypsilanti, MI
National Provider Identifier
1508805243
Registry record updated Aug 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
4301067468 Issued in MI
Practice address
5333 McAuley Dr
Suite 6016
Ypsilanti, MI 48197-1014
Phone
(734) 712-8350
Fax
(734) 712-8351
NPI assigned
Jun 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 4301067468 MI Primary

Addresses

Primary practice location

5333 McAuley Dr
Suite 6016
Ypsilanti, MI 48197-1014

Mailing address

5333 McAuley Dr
Suite 6016
Ypsilanti, MI 48197-1014
Phone (734) 712-8350

Other identifiers 1

IdentifierTypeStateIssuer
4692578MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050216000162 MI Practitioner - Diagnostic Radiology 7810949096 Reassigns benefits to 3 organizations
I20260514000732 WI Practitioner - Diagnostic Radiology 7810949096 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Northwestern University Feinberg Medical School, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology Associates of the Fox Valley SCGroup PAC ID 0446152748, 73 clinicians

Practice addresses (Care Compare)

Ann Arbor, MI 48108
Phone (614) 340-7740

2223 Lime Kiln Rd
Suite 1
Green Bay, WI 54311-6238
Phone (920) 430-8113

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301067468MIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Huron Valley Radiology PC Diagnostic Radiology CurrentSince Mar 15, 2005 Accepting new patients
Radiology Associates of the Fox Valley, SC Diagnostic Radiology CurrentSince Aug 1, 2025 Accepting new patients
X-Ray Consultants Inc Diagnostic Radiology CurrentSince Aug 1, 2024 Accepting new patients
Toledo Radiological Associates, Inc. Diagnostic Radiology Past Accepting new patients
Imaging Central, L.L.C. Past Accepting new patients

Locations

7575 Grand River Rd
Ste 103
Brighton, MI 48114
Phone (866) 522-8268

44405 Woodward Ave
#202
Pontiac, MI 48341
Phone (248) 858-3000

44405 Woodward Ave
Pontiac, MI 48341
Phone (248) 858-3000

5303 Elliott Dr
#2661
Ypsilanti, MI 48197
Phone (734) 712-0280

5333 McAuley Dr
Rm 6016
Ypsilanti, MI 48197

Organizations & group practices 6

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.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377820800000",
    "number": "1508805243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5333 MCAULEY DR",
            "address_2": "SUITE 6016",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971014",
            "telephone_number": "734-712-8350",
            "fax_number": "734-712-8351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5333 MCAULEY DR",
            "address_2": "SUITE 6016",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971014",
            "telephone_number": "734-712-8350",
            "fax_number": "734-712-8351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEISEN",
        "first_name": "SEAN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2013-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301067468",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4692578",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ypsilanti, MI

Sources for this page

Verify at the official NPI Registry.