Active NPI
20TH Street Clinic PC
- Family Medicine Physician
- Battle Creek, MI
National Provider Identifier
1578744918
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 5101004673
- Legal business name
- 20TH STREET CLINIC PC
- Practice address
- 105 N 20TH St
Battle Creek, MI 49015-1746 - Phone
- (269) 969-6010
- Fax
- (269) 964-8422
- NPI assigned
- Nov 14, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Stephen Fedele, DO
- Title
- Owner
- Phone
- (269) 969-6010
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 5101004673 | MI | Primary |
Addresses
Primary practice location
105 N 20TH St
Battle Creek, MI 49015-1746
Mailing address
105 N 20TH St
Battle Creek, MI 49015-1746
Phone (269) 969-6010
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 080A310650 | Other | MI | BCBS |
| 111023860 | Medicaid | MI | |
| 464295 | Other | MI | ADVANTRA FREEDOM |
| CJ8333 | Other | RR MCR | |
| 010057408 | Other | RR MCR P-TAN | |
| 5130499 | Other | MEDICARE ADVANTAGE |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194998400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1364342400000",
"number": "1578744918",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 N 20TH ST",
"city": "BATTLE CREEK",
"state": "MI",
"postal_code": "490151746",
"telephone_number": "269-969-6010",
"fax_number": "269-964-8422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 N 20TH ST",
"city": "BATTLE CREEK",
"state": "MI",
"postal_code": "490151746",
"telephone_number": "269-969-6010",
"fax_number": "269-964-8422"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "20TH STREET CLINIC PC",
"organizational_subpart": "NO",
"enumeration_date": "2007-11-14",
"last_updated": "2013-03-27",
"status": "A",
"authorized_official_last_name": "FEDELE",
"authorized_official_first_name": "STEPHEN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "269-969-6010",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DO"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "MI",
"license": "5101004673",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "080A310650",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "111023860",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ADVANTRA FREEDOM",
"identifier": "464295",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MCR",
"identifier": "CJ8333",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MCR P-TAN",
"identifier": "010057408",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE ADVANTAGE",
"identifier": "5130499",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Battle Creek, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.