NPIMap

Organization Active NPI

Center for Vein Restoration Mi PLLC

  • Surgery Physician
  • Portage, MI
National Provider Identifier
1720388267
Registry record updated May 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
D0053733 Issued in MD
Legal business name
CENTER FOR VEIN RESTORATION MI PLLC
Practice address
3810 W Centre Ave Ste a
Portage, MI 49024-4632
Phone
(301) 860-0930
NPI assigned
Nov 1, 2010
Last updated
May 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2024

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

Authorized official

Name
Lorena Thomas
Title
Credentialing Manager
Phone
(815) 254-1761

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Surgery Physician 208600000X D0053733 MD Primary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X D0053733 MD

Addresses

Primary practice location

3810 W Centre Ave Ste a
Portage, MI 49024-4632

Mailing address

7474 Greenway Center Dr Ste 1000
Greenbelt, MD 20770-3500
Phone (855) 830-8346

Other practice location 1

15255 Northline Rd
Southgate, MI 48195-2487
Phone (855) 830-8346

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110325000303 MI Part B Supplier - Clinic/Group Practice 5092998294 Receives reassigned benefits from 24 practitioners
Practice locations: Southfield, MI; Wyoming, MI; Southgate, MI; Saginaw, MI; Portage, MI; Norton Shores, MI; Midland, MI; Lansing, MI…
O20190517000356 MI DME Supplier - Multi-Specialty - Physician 5092998294 Practice locations: Southgate, MI

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

13530 Michigan Ave
Ste 300
Dearborn, MI 48126
Phone (313) 908-0004

4085 Burton St SE
Ste 101
Grand Rapids, MI 49546

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1288569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717027200000",
    "number": "1720388267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7474 GREENWAY CENTER DR STE 1000",
            "city": "GREENBELT",
            "state": "MD",
            "postal_code": "207703500",
            "telephone_number": "855-830-8346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3810 W CENTRE AVE STE A",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490244632",
            "telephone_number": "301-860-0930"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15255 Northline Rd",
            "address_purpose": "LOCATION",
            "city": "Southgate",
            "state": "MI",
            "postal_code": "481952487",
            "country_code": "US",
            "telephone_number": "855-830-8346",
            "fax_number": "240-473-4321",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CENTER FOR VEIN RESTORATION MI PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-01",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-29",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "LORENA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "815-254-1761"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MD",
            "license": "D0053733",
            "primary": true
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "MD",
            "license": "D0053733",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.