NPIMap

Individual provider Active NPI

Michael Jarvis Prevost, MD

  • Family Medicine Physician
  • Ishpeming, MI
National Provider Identifier
1689735698
Registry record updated Dec 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301056175 Issued in MI
Practice address
901 Lakeshore Dr
Ishpeming, MI 49849-1367
Phone
(906) 485-2687
Fax
(906) 485-2730
NPI assigned
Dec 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 4301056175 MI
Family Medicine Physician 207Q00000X 4301056175 MI Primary

Addresses

Primary practice location

901 Lakeshore Dr
Ishpeming, MI 49849-1367

Mailing address

901 Lakeshore Dr
Ishpeming, MI 49849-1367
Phone (906) 485-2687

Other identifiers 2

IdentifierTypeStateIssuer
MP056175OtherMIBCBS LICENSE
104628209MedicaidMI

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
I20040920000589 MI Practitioner - Family Practice 7517935372 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Human Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bell Physician Practices IncGroup PAC ID 4981833654, 23 clinicians

Practice addresses (Care Compare)

901 Lakeshore Dr
Ishpeming, MI 49849-1367
Phone (906) 485-2687

Hospital & facility affiliations

  • Upper Peninsula Home Health & Hospice Home health agency, Marquette, MI, CCN 237187
  • Upper Peninsula Home Health & Hospice Hospice, Marquette, MI, CCN 231555
  • Lake Superior Life Care & Hospice Hospice, Marquette, MI, CCN 231553
  • Bell Hospital Hospital, Ishpeming, MI, CCN 231321
  • Uphs Marquette DLP Hospital Hospital, Marquette, MI, CCN 230054
  • Marquette County Medical Care Facility Nursing home, Ishpeming, MI, CCN 235321
  • Bell Hospital Nursing home, CCN 23Z321

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bell Physician Practices Inc CurrentSince Dec 1, 2013 Accepting new patients
Bell Physician Practices Inc Family Medicine CurrentSince Dec 1, 2013 Accepting new patients
Acquisition Bell Hospital LLC Past Accepting new patients
Bell Medical Center PastSince Apr 30, 2013 Accepting new patients
Marquette County Medical Care Past Accepting new patients

Locations

901 Lakeshore Dr
Ishpeming, MI 49849
Phone (906) 485-2653

Interoperability endpoints

  • Direct secure messaging: michael.prevost.1@8233.direct.athenahealth.com

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 and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544400000000",
    "number": "1689735698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 LAKESHORE DR",
            "city": "ISHPEMING",
            "state": "MI",
            "postal_code": "498491367",
            "telephone_number": "906-485-2687",
            "fax_number": "906-485-2730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 LAKESHORE DR",
            "city": "ISHPEMING",
            "state": "MI",
            "postal_code": "498491367",
            "telephone_number": "906-485-2687",
            "fax_number": "906-485-2730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PREVOST",
        "first_name": "MICHAEL",
        "middle_name": "JARVIS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2018-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MI",
            "license": "4301056175",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301056175",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS LICENSE",
            "identifier": "MP056175",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104628209",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ishpeming, MI

Sources for this page

Verify at the official NPI Registry.