NPIMap

Individual provider Active NPI

Ian Jacob Anderson, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Detroit, MI
National Provider Identifier
1669884433
Registry record updated May 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
4301101517 Issued in MI
Practice address
22101 Moross Rd # CCB-SB
Detroit, MI 48236-2148
Phone
(313) 343-3520
NPI assigned
May 28, 2014
Last updated
May 26, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 4301101517 MI Primary

Addresses

Primary practice location

22101 Moross Rd # CCB-SB
Detroit, MI 48236-2148

Mailing address

22101 Moross Rd # CCB-SB
Detroit, MI 48236-2148

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, KS, UT3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20220908003001 CO Practitioner - Pathology 9537454897 Reassigns benefits to 1 organization
I20220915000906 KS Practitioner - Pathology 9537454897 Reassigns benefits to 1 organization
I20250130000581 UT Practitioner - Pathology 9537454897 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain States Pathology PCGroup PAC ID 4284616293, 16 clinicians

Practice addresses (Care Compare)

1600 W Antelope Dr
Layton, UT 84041-1142
Phone (801) 807-1000

2222 N Nevada Ave
Colorado Springs, CO 80907-6819
Phone (719) 776-5816

401 E Spruce St
St Catherine's Hospital
Garden City, KS 67846-5679
Phone (620) 272-2222

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.8 of 100Reported as group
Quality
85
Improvement activities
40
Cost
76.83

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain States Pathology Anatomic Pathology & Clinical Pathology CurrentSince Aug 15, 2022 Accepting new patients
Mountain States Pathology PC Anatomic Pathology & Clinical Pathology CurrentSince Aug 15, 2022 Accepting new patients

Locations

2222 N Nevada Ave
Colorado Springs, CO 80907
Phone (719) 776-5333

6001 E Woodmen Rd
Colorado Springs, CO 80923
Phone (719) 571-1000

1010 Three Springs Blvd
Durango, CO 81301
Phone (970) 247-4311

1950 Mountain View Ave
Longmont, CO 80501
Phone (303) 651-5000

1008 Minnequa Ave
Pueblo, CO 81004
Phone (719) 557-5656

401 E Spruce St
Garden City, KS 67846
Phone (620) 272-2222

5700 Southwyck Blvd
Toledo, OH 43614

1600 W Antelope Dr
Layton, UT 84041
Phone (801) 807-1000

Organizations & group practices 2

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1401235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1495756800000",
    "number": "1669884433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22101 MOROSS RD # CCB-SB",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22101 MOROSS RD # CCB-SB",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362148",
            "telephone_number": "313-343-3520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "IAN",
        "middle_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-28",
        "last_updated": "2017-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MI",
            "license": "4301101517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.