Active NPI
Allan L Ippolito, M.D.
- Vascular Surgery Physician
- Flint, MI
National Provider Identifier
1700857273
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Surgery Physician
- License
- AI044692
- Practice address
- 5020 W Bristol Rd
Flint, MI 48507-2919 - Phone
- (810) 732-1620
- Fax
- (810) 732-8559
- NPI assigned
- Jan 31, 2006
- 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 |
|---|---|---|---|---|
| Vascular Surgery Physician | 2086S0129X | AI044692 | MI | Primary |
Addresses
Primary practice location
5020 W Bristol Rd
Flint, MI 48507-2919
Mailing address
5020 W Bristol Rd
Flint, MI 48507-2919
Phone (810) 732-1620
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1430937 | Medicaid | MI | |
| 0202507492 | Other | MI | BC/BS OF MICHIGAN |
| C5093 | Other | MI | M-CARE |
| 113784 | Other | MI | GREAT LAKES HEALTH PLAN |
| B47732 | Other | MI | HEALTH ALLIANCE PLAN |
| 0601232 | Other | MI | HEALTHPLUS OF MICHIGAN |
| 204104 | Other | MI | MCLAREN HEALTH PLAN/ADVAN |
| 120886 | Other | MI | CARE CHOICE HMO |
| 4292691 | Other | MI | AETNA |
| 120886 | Other | MI | PREFERRED CHOICE PPO |
| 382237803107 | Other | MI | COMMUNITY CHOICE |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170426000751 | MI | Order and Referring Only - Vascular Surgery | 9032190020 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AI044692 | MI | MD | Vascular Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196121600000",
"number": "1700857273",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5020 W BRISTOL RD",
"city": "FLINT",
"state": "MI",
"postal_code": "485072919",
"telephone_number": "810-732-1620",
"fax_number": "810-732-8559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5020 W BRISTOL RD",
"city": "FLINT",
"state": "MI",
"postal_code": "485072919",
"telephone_number": "810-732-1620",
"fax_number": "810-732-8559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IPPOLITO",
"first_name": "ALLAN",
"middle_name": "L",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-31",
"last_updated": "2007-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "MI",
"license": "AI044692",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1430937",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS OF MICHIGAN",
"identifier": "0202507492",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "M-CARE",
"identifier": "C5093",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GREAT LAKES HEALTH PLAN",
"identifier": "113784",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE PLAN",
"identifier": "B47732",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPLUS OF MICHIGAN",
"identifier": "0601232",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCLAREN HEALTH PLAN/ADVAN",
"identifier": "204104",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARE CHOICE HMO",
"identifier": "120886",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4292691",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED CHOICE PPO",
"identifier": "120886",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMUNITY CHOICE",
"identifier": "382237803107",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flint, MI
- Internal Medicine Associates of Flint P.C.
- Internal Medicine Associates of Miller Rd
- Internal Medicine Associates, PC
- Internal Medicine Consultants, PC
- Internal Medicine Health Center PC
- Hafiza Zanish Iram, MD
- Sofia Iram, MD
- Irb Medical Equipment, LLC (Hart Medical Equipment)
- Irb Medical Equipment, LLC (Hart Medical Equipment)
- Ireign Counseling Services
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.