Individual provider Active NPI

Anthony V Izokaitis, DO

  • Family Medicine Physician
  • Fruitport, MI
National Provider Identifier
1699752477
Registry record updated Dec 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101013994 Issued in MI
Practice address
3443 Farr Rd
Fruitport, MI 49415-8779
Phone
(231) 672-2900
Fax
(231) 672-2901
NPI assigned
Dec 22, 2005
Last updated
Dec 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2021

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 5101013994 MI Primary

Addresses

Primary practice location

3443 Farr Rd
Fruitport, MI 49415-8779

Mailing address

PO Box 1848
Muskegon, MI 49443-1848
Phone (231) 672-2900

Other identifiers 1

IdentifierTypeStateIssuer
4322110MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address aizokaitis26124@direct.trinity-health.org Direct

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
I20090119000108 MI Practitioner - Family Practice 1658434659 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Physician NetworkGroup PAC ID 8921996307, 109 clinicians

Practice addresses (Care Compare)

3443 Farr Rd
Fruitport, MI 49415-8779
Phone (231) 672-2900

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Physician Network Family Medicine Current Accepting new patients
Mercy Physician Network Family Medicine CurrentSince Jul 9, 2001 Accepting new patients
Mercy Urgent Care Family Medicine Past Accepting new patients

Locations

3443 Farr Rd
Fruitport, MI 49415
Phone (231) 672-2900

1700 Oak Ave
Muskegon, MI 49442
Phone (231) 672-6430

2006 Holton Rd
North Muskegon, MI 49445
Phone (231) 672-3333

Interoperability endpoints

  • Direct secure messaging: aizokaitis26124@direct.trinity-health.org
  • FHIR API: https://api.platform.athenahealth.com/13864/brand/1/csg/1/fhir/r4

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.

Hospital & facility affiliations 4

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": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639612800000",
    "number": "1699752477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1848",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494431848",
            "telephone_number": "231-672-2900",
            "fax_number": "231-672-2901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3443 FARR RD",
            "city": "FRUITPORT",
            "state": "MI",
            "postal_code": "494158779",
            "telephone_number": "231-672-2900",
            "fax_number": "231-672-2901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IZOKAITIS",
        "first_name": "ANTHONY",
        "middle_name": "V",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-22",
        "last_updated": "2021-12-16",
        "certification_date": "2021-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101013994",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4322110",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aizokaitis26124@direct.trinity-health.org",
            "affiliation": "N",
            "endpointDescription": "Mercy Health Physician Partners",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "office",
            "address_1": "3443 Farr Rd",
            "city": "Fruitport",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494158779",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fruitport, MI

Sources for this page

Verify at the official NPI Registry.