Individual provider Active NPI

Michael Matthew Lupo, PA-C

  • Physician Assistant
  • Bay City, MI
National Provider Identifier
1710432646
Registry record updated Apr 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
3884 Monitor Rd
Bay City, MI 48706-9298
Phone
(989) 671-2000
NPI assigned
Aug 21, 2016
Last updated
Apr 12, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2021

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 Primary

Addresses

Primary practice location

3884 Monitor Rd
Bay City, MI 48706-9298

Mailing address

3884 Monitor Rd
Bay City, MI 48706-9298
Phone (989) 671-2000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address michael.lupo@direct.medfusion.com

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
I20201118002166 MI Practitioner - Physician Assistant 8527479799 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Great Lakes Bay Health Centers CurrentSince Dec 14, 2020 Accepting new patients
Great Lakes Bay Health Centers CurrentSince Dec 14, 2020 Accepting new patients

Locations

3884 Monitor Rd
Bay City, MI 48706
Phone (989) 671-2000

501 Lapeer Ave
Saginaw, MI 48607
Phone (989) 753-6000

501 Lapeer Ave
#R
Saginaw, MI 48607
Phone (989) 753-6000

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1471737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618185600000",
    "number": "1710432646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3884 MONITOR RD",
            "city": "BAY CITY",
            "state": "MI",
            "postal_code": "487069298",
            "telephone_number": "989-671-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3884 MONITOR RD",
            "city": "BAY CITY",
            "state": "MI",
            "postal_code": "487069298",
            "telephone_number": "989-671-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUPO",
        "first_name": "MICHAEL",
        "middle_name": "MATTHEW",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-21",
        "last_updated": "2021-04-12",
        "certification_date": "2021-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "michael.lupo@direct.medfusion.com",
            "affiliation": "N",
            "address_1": "3884 Monitor Rd",
            "city": "Bay City",
            "state": "MI",
            "country_code": "US",
            "postal_code": "487069298",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bay City, MI

Sources for this page

Verify at the official NPI Registry.