Individual provider Active NPI

Kyle Richter, PA

  • Physician Assistant
  • Grand Blanc, MI
National Provider Identifier
1710089768
Registry record updated Apr 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601004434 Issued in MI
Practice address
3452 Genesys Pkwy
Grand Blanc, MI 48439-7334
Phone
(810) 606-7550
NPI assigned
Sep 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601004434 MI Primary

Addresses

Primary practice location

3452 Genesys Pkwy
Grand Blanc, MI 48439-7334

Mailing address

3399 Pollock Rd
Grand Blanc, MI 48439-8393
Phone (810) 603-0170

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050119000066 MI Practitioner - Physician Assistant 9537118468 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Genesys Practice Partners IncGroup PAC ID 3476456492, 37 clinicians

Practice addresses (Care Compare)

1 Genesys Pkwy
Grand Blanc, MI 48439-8065

3399 Pollock Rd
Suite a
Grand Blanc, MI 48439-8395
Phone (810) 606-7550

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601004434MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Genesys Practice Partners Inc CurrentSince Apr 29, 2013 Accepting new patients
Stat Care PC Past Accepting new patients
Statcare PC Physician Assistant Past Accepting new patients
Genesys Practice Partners Inc Physician Assistant Past Accepting new patients

Locations

1460 N Center Rd
Burton, MI 48509
Phone (810) 424-2011

3399 Pollock Rd
Ste A
Grand Blanc, MI 48439
Phone (810) 606-7550

1 Genesys Pkwy
Grand Blanc, MI 48439
Phone (810) 606-5733

3399 Pollock Rd
Grand Blanc, MI 48439
Phone (810) 603-0170

1 Genesys Pkwy
Ste 4620
Grand Blanc, MI 48439
Phone (810) 606-1460

Interoperability endpoints

  • Direct secure messaging: kyle.richter.1@8209.direct.athenahealth.com

Organizations & group practices 6

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 1

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": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366934400000",
    "number": "1710089768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3399 POLLOCK RD",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484398393",
            "telephone_number": "810-603-0170",
            "fax_number": "810-579-1705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3452 GENESYS PKWY",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484397334",
            "telephone_number": "810-606-7550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHTER",
        "first_name": "KYLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-01",
        "last_updated": "2013-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Blanc, MI

Sources for this page

Verify at the official NPI Registry.