NPIMap

Organization Active NPI

McLaren Medical Group

  • Internal Medicine Physician
  • Burton, MI
National Provider Identifier
1659418663
Registry record updated Feb 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MCLAREN MEDICAL GROUP
Practice address
1459 S Center Rd
Burton, MI 48509-1726
Phone
(810) 496-0900
Fax
(810) 742-3891
NPI assigned
Jan 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2016

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

Authorized official

Name
Mr. William Hardimon
Title
Ceo
Phone
(810) 342-1040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1459 S Center Rd
Burton, MI 48509-1726

Mailing address

401 S Ballenger Hwy
Flint, MI 48532-3638
Phone (810) 342-1000

Other identifiers 1

IdentifierTypeStateIssuer
110B510530OtherMIBLUE CROSS BLUE SHIELD

Other names 1

  • McLaren Medical Managment, Inc. Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031106000025 MI Part B Supplier - Clinic/Group Practice 3971416082 Receives reassigned benefits from 458 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455235200000",
    "number": "1659418663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 S BALLENGER HWY",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323638",
            "telephone_number": "810-342-1000",
            "fax_number": "810-342-1590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1459 S CENTER RD",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485091726",
            "telephone_number": "810-496-0900",
            "fax_number": "810-742-3891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLAREN MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2016-02-12",
        "status": "A",
        "authorized_official_last_name": "HARDIMON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "810-342-1040",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "110B510530",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McLaren Medical Managment, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Burton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.