Active NPI
Timothy J Izzo, DO
- Family Medicine Physician
- Grand Ledge, MI
National Provider Identifier
1720152846
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- TI011387
- Practice address
- 1035 Charlevoix Dr
Suite 100
Grand Ledge, MI 48837-2223 - Phone
- (517) 627-2181
- Fax
- (517) 622-1242
- NPI assigned
- Nov 20, 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | TI011387 | MI | Primary |
Addresses
Primary practice location
1035 Charlevoix Dr
Suite 100
Grand Ledge, MI 48837-2223
Mailing address
1035 Charlevoix Dr
Suite 100
Grand Ledge, MI 48837-2223
Phone (517) 627-2181
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0852328574 | Other | MI | BCBS INDIVIDUAL PIN |
| 080079681 | Other | MEDICARE RAILROAD | |
| P85301 | Other | MI | BCN PIN NUMBER |
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
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Michigan State University College of Osteopathic Medicine, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1035 Charlevoix Dr
Suite 100
Grand Ledge, MI 48837-2223
Phone (517) 627-2181
Hospital & facility affiliations
- Edward W Sparrow Hospital
- McLaren Greater Lansing
- Sparrow Ionia Hospital
- University of Michigan Health - Sparrow Eaton
- University of Michigan Health- Sparrow Clinton
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TI011387 | MI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| David J. Smith MD PC | Family Medicine | Current | Accepting new patients |
Locations
1035 Charlevoix Dr
Ste 100
Grand Ledge, MI 48837
Phone (517) 622-6446
Interoperability endpoints
- tim.izzo@fmom.directbygreenway.com
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Grand Ledge, MI
- NPI 1669523650
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Lansing, MI
- NPI 1073588711
-
- General Acute Care Hospital
- Lansing, MI
- NPI 1760710719
-
- General Acute Care Hospital
- Lansing, MI
- NPI 1134104672
-
- Critical Access Hospital
- Saint Johns, MI
- NPI 1093809824
-
- Critical Access Hospital
- Charlotte, MI
- NPI 1942254529
-
- Critical Access Hospital
- Ionia, MI
- NPI 1700820065
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391040000000",
"number": "1720152846",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1035 CHARLEVOIX DR",
"address_2": "SUITE 100",
"city": "GRAND LEDGE",
"state": "MI",
"postal_code": "488372223",
"telephone_number": "517-627-2181",
"fax_number": "517-622-1242"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1035 CHARLEVOIX DR",
"address_2": "SUITE 100",
"city": "GRAND LEDGE",
"state": "MI",
"postal_code": "488372223",
"telephone_number": "517-627-2181",
"fax_number": "517-622-1242"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IZZO",
"first_name": "TIMOTHY",
"middle_name": "J",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-20",
"last_updated": "2014-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "TI011387",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS INDIVIDUAL PIN",
"identifier": "0852328574",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "080079681",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCN PIN NUMBER",
"identifier": "P85301",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Ledge, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2014; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.