NPIMap

Individual provider Active NPI

Gary Peppin, M.D.

  • Internal Medicine Physician
  • Ann Arbor, MI
National Provider Identifier
1588676399
Registry record updated Dec 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301057654 Issued in MI
Practice address
4350 Jackson Rd
Suite 200
Ann Arbor, MI 48103-1889
Phone
(734) 761-2581
Fax
(734) 995-0425
NPI assigned
Aug 12, 2006
Last updated
Dec 14, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301057654 MI Primary

Addresses

Primary practice location

4350 Jackson Rd
Suite 200
Ann Arbor, MI 48103-1889

Mailing address

24 Frank Lloyd Wright Dr
J2000
Ann Arbor, MI 48105-9484
Phone (734) 747-6766

Other identifiers 1

IdentifierTypeStateIssuer
1588676399MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040929001065 MI Practitioner - Internal Medicine 7618946245 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Michigan State University College of Human Medicine, 1991
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)

4200 Whitehall Dr
Suite 350
Ann Arbor, MI 48105-9694
Phone (734) 572-9600

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Health Services Corporation Current Accepting new patients
Iha Health Services Corporation Internal Medicine CurrentSince Feb 1, 2015 Accepting new patients
Iha Health Services Corporation Past Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients
Iha Health Services Corporation Past Accepting new patients

Locations

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

4200 Whitehall Dr
Ste 350
Ann Arbor, MI 48105
Phone (734) 572-9600

Organizations & group practices 5

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": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481673600000",
    "number": "1588676399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 FRANK LLOYD WRIGHT DR",
            "address_2": "J2000",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481059484",
            "telephone_number": "734-747-6766",
            "fax_number": "734-222-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4350 JACKSON RD",
            "address_2": "SUITE 200",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481031889",
            "telephone_number": "734-761-2581",
            "fax_number": "734-995-0425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEPPIN",
        "first_name": "GARY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2016-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301057654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1588676399",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.