Individual provider Active NPI

Michael J Heidenreich, MD

  • Vascular Surgery Physician
  • Ypsilanti, MI
National Provider Identifier
1578507554
Registry record updated Sep 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
4301082301 Issued in MI
Practice address
5325 Elliott Dr
Suite 104
Ypsilanti, MI 48197-8633
Phone
(734) 712-8150
Fax
(734) 712-8151
NPI assigned
Jun 16, 2006
Last updated
Sep 19, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 4301082301 MI Primary

Addresses

Primary practice location

5325 Elliott Dr
Suite 104
Ypsilanti, MI 48197-8633

Mailing address

5325 Elliott Dr
Suite 104
Ypsilanti, MI 48197-8633
Phone (734) 712-8150

Other identifiers 1

IdentifierTypeStateIssuer
4516694-10MedicaidMI

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
I20040108000445 MI Practitioner - Vascular Surgery 5799684791 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
University of Pittsburgh School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Iha Health Services CorporationGroup PAC ID 2466351440, 1,149 clinicians

Practice addresses (Care Compare)

128 Van Buren St
Chelsea, MI 48118-1623
Phone (734) 475-8677

20555 Victor Pkwy
Livonia, MI 48152-7031

2305 Genoa Bus Park Dr
Brighton, MI 48114-7005

44428 Woodward Ave
Suite 102
Pontiac, MI 48341-5009
Phone (734) 712-8700

51341 W Huron River Dr
Trinity Health Iha Medical Group Primary Ca
Van Buren Township, MI 48111-2571
Phone (734) 997-0304

5301 E Huron River Dr
Ypsilanti, MI 48197-1051

5301 McAuley Dr
Ypsilanti, MI 48197-1051

5325 Elliott Dr
Ypsilanti, MI 48197-8633

620 Byron Rd
Howell, MI 48843-1002

7575 Grand River Rd
Brighton, MI 48114-9309
Phone (734) 712-7255

7575 Grand River Rd
Brighton, MI 48114-9390

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion1-10
Varicose vein removal37
Leg revascularization (restoring blood flow)25
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301082301MIMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Health Services Corporation Current Accepting new patients
Iha Health Services Corporation Vascular Surgery CurrentSince May 30, 2013 Accepting new patients
Iha Health Service Corporation CurrentSince May 30, 2013 Accepting new patients
Iha Health Services Corporation Past Accepting new patients
Michigan Heart PC Past Accepting new patients
Michigan Multispecialty Physicians, P.C. Vascular Surgery Past Accepting new patients

Locations

16507 Southfield Rd
Allen Park, MI 48101
Phone (313) 389-0648

2305 Genoa Business Park Dr
Ste 200
Brighton, MI 48114
Phone (810) 494-6840

7575 Grand River Rd
Ste 202
Brighton, MI 48114
Phone (810) 844-7566

49650 Cherry Hill Rd
Ste 120
Canton, MI 48187
Phone (734) 398-7800

128 Van Buren St
Chelsea, MI 48118
Phone (734) 475-8677

775 S Main St
Chelsea, MI 48118
Phone (313) 995-3764

44428 Woodward Ave
Ste 102
Pontiac, MI 48341
Phone (734) 712-8700

5301 McAuley Dr
Ypsilanti, MI 48197
Phone (734) 712-7246

5325 Elliott Dr
Ste 103
Ypsilanti, MI 48197
Phone (313) 572-5589

5325 Elliott Dr
Ste 104
Ypsilanti, MI 48197
Phone (734) 434-4200

5325 Elliott Dr
Ste 203
Ypsilanti, MI 48197
Phone (734) 712-8020

5333 McAuley Dr
Rm 3001
Ypsilanti, MI 48197
Phone (734) 712-4120

5333 McAuley Dr
Rm 4003
Ypsilanti, MI 48197
Phone (734) 712-3470

5333 McAuley Dr
Rm 4016
Ypsilanti, MI 48197
Phone (734) 712-4310

Interoperability endpoints

  • Direct secure messaging: mheidenreich45650@direct.trinity-health.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348012800000",
    "number": "1578507554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5325 ELLIOTT DR",
            "address_2": "SUITE 104",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481978633",
            "telephone_number": "734-712-8150",
            "fax_number": "734-712-8151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5325 ELLIOTT DR",
            "address_2": "SUITE 104",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481978633",
            "telephone_number": "734-712-8150",
            "fax_number": "734-712-8151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEIDENREICH",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2012-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MI",
            "license": "4301082301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4516694-10",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ypsilanti, MI

Sources for this page

Verify at the official NPI Registry.