Individual provider Active NPI

Kyle Anthony Nedic, M.D.

  • General Practice Physician
  • Marysville, MI
National Provider Identifier
1538519988
Registry record updated May 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
4301117042 Issued in MI
Practice address
3350 Gratiot Blvd
Marysville, MI 48040-2121
Phone
(810) 364-4000
Fax
(810) 364-5995
NPI assigned
Jun 16, 2016
Last updated
May 21, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 4301117042 MI
General Practice Physician 208D00000X 4301117042 MI Primary

Addresses

Primary practice location

3350 Gratiot Blvd
Marysville, MI 48040-2121

Mailing address

3050 Commerce Dr
Fort Gratiot, MI 48059-3819
Phone (810) 385-4441

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
I20190618003303 MI Practitioner - General PracticePractitioner - Emergency Medicine 1850625260 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Healthcare Network PCGroup PAC ID 3476456252, 30 clinicians

Practice addresses (Care Compare)

3350 Gratiot Blvd
Marysville, MI 48040-2121
Phone (810) 364-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.49 of 100Reported as individual
Quality
69.33
Improvement activities
40
Cost
72.04

Merit-based Incentive Payment System (MIPS)

Final score
89.52 of 100Reported as group
Quality
89.56
Promoting interoperability
100
Improvement activities
40
Cost
70.58

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301117042MIMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Healthcare Network, PC Emergency Medicine CurrentSince Nov 1, 2024 Accepting new patients
Emergency Professionals of Michigan, P.C. Emergency Medicine CurrentSince Jul 1, 2019 Accepting new patients
Physician Healthcare Network, PC Past Accepting new patients

Locations

7300 N Canton Center Rd
Canton, MI 48187
Phone (734) 454-8001

3050 Commerce Dr
Fort Gratiot, MI 48059
Phone (810) 385-4441

36267 26 Mile Rd
Ste 3
Lenox, MI 48048
Phone (586) 716-1371

3350 Gratiot Blvd
Marysville, MI 48040
Phone (810) 364-4000

826 W King St
Owosso, MI 48867
Phone (989) 720-2273

5450 Fort St
Woodhaven, MI 48183
Phone (734) 671-3297

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11357/brand/3/csg/1/fhir/r4
  • Direct secure messaging: kyle.nedic.1@11357.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747785600000",
    "number": "1538519988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3050 COMMERCE DR",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593819",
            "telephone_number": "810-385-4441",
            "fax_number": "810-385-1951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 GRATIOT BLVD",
            "city": "MARYSVILLE",
            "state": "MI",
            "postal_code": "480402121",
            "telephone_number": "810-364-4000",
            "fax_number": "810-364-5995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEDIC",
        "first_name": "KYLE",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-16",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4301117042",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "4301117042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marysville, MI

Sources for this page

Verify at the official NPI Registry.