Individual provider Active NPI

Anthony Joseph Camodeca, DO

  • Emergency Medicine Physician
  • Wyoming, MI
National Provider Identifier
1710407572
Registry record updated Jun 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
5101023154 Issued in MI
Practice address
5900 Byron Center Ave SW
Wyoming, MI 49519-9606
Phone
(616) 252-7200
NPI assigned
Jun 22, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 5101023154 MI Primary

Addresses

Primary practice location

5900 Byron Center Ave SW
Wyoming, MI 49519-9606

Mailing address

5900 Byron Center Ave SW
Wyoming, MI 49519-9606

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, IA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20191121002521 MI Practitioner - Emergency Medicine 6709155351 Reassigns benefits to 1 organization
I20200609000366 IA Practitioner - Emergency Medicine 6709155351 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Des Moines River Physicians LLCGroup PAC ID 0143549634, 45 clinicians

Practice addresses (Care Compare)

1111 6TH Ave
Des Moines, IA 50314-2613
Phone (515) 247-3121

Hospital & facility affiliations

  • Mercyone Des Moines Medical Center Hospital, Des Moines, IA, CCN 160083

Merit-based Incentive Payment System (MIPS)

Final score
85.29 of 100Reported as group
Quality
80.31
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101023154MIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Des Moines River Physicians, LLC Emergency Medicine CurrentSince May 15, 2020 Accepting new patients
Ascension Borgess Hospital CurrentSince Dec 18, 2019 Accepting new patients
Ascension Borgess Hospital CurrentSince Dec 18, 2019 Accepting new patients
Ascension Borgess Hospital Current Accepting new patients
Des Moines River Physicians, LLC Emergency Medicine Current Accepting new patients

Locations

1111 6th Ave
Des Moines, IA 50314
Phone (515) 247-3121

204 N 4th Ave E
Newton, IA 50208
Phone (641) 791-4800

1755 59th Pl
West Des Moines, IA 50266
Phone (515) 247-4240

1717 Shaffer St
Ste 002
Kalamazoo, MI 49048

1521 Gull Rd
Kalamazoo, MI 49048
Phone (269) 226-5165

411 Naomi St
Plainwell, MI 49080
Phone (269) 685-0700

7901 Angling Rd
Portage, MI 49024
Phone (269) 324-8405

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

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 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": "1498089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1498089600000",
    "number": "1710407572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 BYRON CENTER AVE SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495199606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 BYRON CENTER AVE SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495199606",
            "telephone_number": "616-252-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMODECA",
        "first_name": "ANTHONY",
        "middle_name": "JOSEPH",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-22",
        "last_updated": "2017-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101023154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyoming, MI

Sources for this page

Verify at the official NPI Registry.