Individual provider Active NPI

Larry Wile

  • Family Medicine Physician
  • Portage, MI
National Provider Identifier
1679683635
Registry record updated Dec 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301058485 Issued in MI
Practice address
2700 E Centre Ave
Portage, MI 49002-5500
Phone
(269) 286-7050
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301058485 MI Primary

Addresses

Primary practice location

2700 E Centre Ave
Portage, MI 49002-5500

Mailing address

5943 Stadium Dr
Suite 3
Kalamazoo, MI 49009-3016

Other practice location 1

7901 Angling Rd
Suite B-201
Portage, MI 49024-0714
Phone (269) 324-8600

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.bronsonhg.org Direct Bronson Healthcare Group

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100116000416 MI Practitioner - Family Practice 3072655810 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301058485MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group Promed Family Medicine Current Accepting new patients
Ascension Medical Group Promed CurrentSince Jan 1, 1995 Accepting new patients
Promed Healthcare CurrentSince Jan 1, 1995 Accepting new patients

Locations

5943 Stadium Dr
Ste 3
Kalamazoo, MI 49009
Phone (269) 226-8315

7901 Angling Rd
Ste B-201
Portage, MI 49024
Phone (269) 324-8600

7901 Angling Rd
Portage, MI 49024
Phone (269) 324-8405

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607558400000",
    "number": "1679683635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5943 STADIUM DR",
            "address_2": "SUITE 3",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490093016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 E CENTRE AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490025500",
            "telephone_number": "269-286-7050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7901 Angling Rd",
            "address_2": "Suite B-201",
            "address_purpose": "LOCATION",
            "city": "Portage",
            "state": "MI",
            "postal_code": "490240714",
            "country_code": "US",
            "telephone_number": "269-324-8600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILE",
        "first_name": "LARRY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301058485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson HealthCare Group Direct Address",
            "affiliationName": "Bronson Healthcare Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portage, MI

Sources for this page

Verify at the official NPI Registry.