NPIMap

Organization Active NPI

Michigan State University

  • Surgery Physician
  • East Lansing, MI
National Provider Identifier
1699725895
Registry record updated Oct 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
MICHIGAN STATE UNIVERSITY
Practice address
4660 S Hagadorn Rd Ste 600
East Lansing, MI 48823-5383
Phone
(517) 267-2460
Fax
(517) 884-8602
NPI assigned
May 11, 2006
Last updated
Oct 18, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2019

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

Authorized official

Name
Lisa Rucker
Title
Enrollment & Patient Accts Manager
Phone
(517) 355-8462

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X
Hematology & Oncology Physician 207RH0003X
Infectious Disease Physician 207RI0200X
Obstetrics & Gynecology Physician 207V00000X
Reproductive Endocrinology Physician 207VE0102X
Otolaryngology Physician 207Y00000X 4301097695 MI
Surgery Physician 208600000X Primary
Surgical Critical Care Physician 2086S0102X
Trauma Surgery Physician 2086S0127X
Surgical Oncology Physician 2086X0206X 4301077538 MI

Addresses

Primary practice location

4660 S Hagadorn Rd Ste 600
East Lansing, MI 48823-5383

Mailing address

804 Service Rd Ste A109B
East Lansing, MI 48824-7015
Phone (517) 267-2460

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031105000741 MI Part B Supplier - Clinic/Group Practice 3870405954 Receives reassigned benefits from 94 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: East Lansing, MI; Okemos, MI; Lansing, MI; Eaton Rapids, MI
O20031106000079 MI Part B Supplier - Clinic/Group Practice 3870405954 Receives reassigned benefits from 52 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Haslett, MI; East Lansing, MI; Lansing, MI; Grand Rapids, MI; Eaton Rapids, MI; Charlotte, MI
O20031218000492 MI Part B Supplier - Clinic/Group Practice 3870405954 Receives reassigned benefits from 23 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: East Lansing, MI; Lansing, MI

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory

Locations

804 Service Rd
#109F
East Lansing, MI 48824

Practitioners & affiliated clinicians

Practitioners 57

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.

View all 57

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571356800000",
    "number": "1699725895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 SERVICE RD STE A109B",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247015",
            "telephone_number": "517-267-2460",
            "fax_number": "517-884-8602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4660 S HAGADORN RD STE 600",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488235383",
            "telephone_number": "517-267-2460",
            "fax_number": "517-884-8602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2019-10-18",
        "status": "A",
        "authorized_official_last_name": "RUCKER",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "ENROLLMENT & PATIENT ACCTS MANAGER",
        "authorized_official_telephone_number": "517-355-8462"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207VE0102X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Reproductive Endocrinology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MI",
            "license": "4301097695",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": "MI",
            "license": "4301077538",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Lansing, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2019; 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.