NPIMap

Individual provider Active NPI

Marjorie V Funtanilla, MD

  • Nephrology Physician
  • Iron Mountain, MI
National Provider Identifier
1730161555
Registry record updated Jul 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
4301071282 Issued in MI
Practice address
1711 S Stephenson Ave
Suite 225
Iron Mountain, MI 49801-3639
Phone
(906) 776-5860
Fax
(906) 776-5833
NPI assigned
Nov 17, 2005
Last updated
Jul 10, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 4301071282 MI Primary

Addresses

Primary practice location

1711 S Stephenson Ave
Suite 225
Iron Mountain, MI 49801-3639

Mailing address

PO Box 549
Iron Mountain, MI 49801-0549
Phone (906) 774-1313

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071102000254 MI Practitioner - NephrologyPractitioner - Internal Medicine 8325135684 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1721 S Stephenson Ave
Iron Mountain, MI 49801-3637
Phone (906) 774-1313

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
MCHS Hospitals Inc Current Accepting new patients
Dickinson County Healthcare System Nephrology CurrentSince Mar 1, 2007 Accepting new patients
Dickinson County Healthcare System Nephrology CurrentSince Mar 1, 2007 Accepting new patients

Locations

1711 S Stephenson Ave
Ste 225
Iron Mountain, MI 49801
Phone (906) 776-5860

1721 S Stephenson Ave
Iron Mountain, MI 49801
Phone (906) 776-5415

Interoperability endpoints

  • Direct secure messaging: marjorie.funtanilla.1@22710.direct.athenahealth.com
  • Direct secure messaging: marjorie.funtanilla@marshfieldclinichealthsystem.cernerdirect.com

Organizations & group practices 3

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.

Hospital & facility affiliations 7

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": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341878400000",
    "number": "1730161555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 549",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498010549",
            "telephone_number": "906-774-1313",
            "fax_number": "906-776-5639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 S STEPHENSON AVE",
            "address_2": "SUITE 225",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498013639",
            "telephone_number": "906-776-5860",
            "fax_number": "906-776-5833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNTANILLA",
        "first_name": "MARJORIE",
        "middle_name": "V",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-17",
        "last_updated": "2012-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MI",
            "license": "4301071282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Iron Mountain, MI

Sources for this page

Verify at the official NPI Registry.