Active NPI
Ray Alvin Breitenbach, M.D.
- Family Medicine Physician
- Waterford, MI
National Provider Identifier
1679541940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4301404572
- Practice address
- 3901 Highland Rd
Suite D
Waterford, MI 48328-2162 - Phone
- (248) 682-3070
- Fax
- (248) 682-3626
- NPI assigned
- Mar 10, 2006
- Last updated
- Jun 28, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301404572 | MI | Primary |
Addresses
Primary practice location
3901 Highland Rd
Suite D
Waterford, MI 48328-2162
Mailing address
3901 Highland Rd
Suite D
Waterford, MI 48328-2162
Phone (248) 682-3070
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 104680165 | Medicaid | MI | |
| 700F37550 | Other | MI | BCBSM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SJMH Medical Practice-SMHC | Past | Accepting new patients | |
| Airport Family Physicians LLC | Family Medicine | Past | Accepting new patients |
| Unicare Home Health, Inc | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Family Medicine Physician
- Waterford, MI
- NPI 1417130303
-
- Internal Medicine Physician
- Pontiac, MI
- NPI 1346284684
-
- Home Health Agency
- Clarkston, MI
- NPI 1598867897
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309219200000",
"number": "1679541940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3901 HIGHLAND RD",
"address_2": "SUITE D",
"city": "WATERFORD",
"state": "MI",
"postal_code": "483282162",
"telephone_number": "248-682-3070",
"fax_number": "248-682-3626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3901 HIGHLAND RD",
"address_2": "SUITE D",
"city": "WATERFORD",
"state": "MI",
"postal_code": "483282162",
"telephone_number": "248-682-3070",
"fax_number": "248-682-3626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREITENBACH",
"first_name": "RAY",
"middle_name": "ALVIN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-10",
"last_updated": "2011-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4301404572",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "104680165",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM",
"identifier": "700F37550",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waterford, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.