Marjorie V Funtanilla, MD
Individual provider Active NPI Nephrology Physician · Iron Mountain, MI
NPI 1730161555 · NPPES record last updated Jul 10, 2012
Key facts
- NPI
- 1730161555
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nephrology Physician 207RN0300X
- License
- 4301071282 (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
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 16
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Nephrology
- Education
- Other, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Dickinson County Healthcare System
Practice addresses (Care Compare)
1721 S Stephenson Ave
Iron Mountain, MI 49801-3637
Phone (906) 774-1313
Hospital & facility affiliations
- Fresenius - Iron Mountain
- Dickinson Home Health
- Marshfield Medical Center
- Dickinson County Memorial Hospital
- Aspirus Iron River Hospital & Clinics, Inc
- Osf St Francis Hospital and Medical Group
- Uphs Marquette DLP Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20071102000254 | MI | Practitioner - Nephrology |
8325135684 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dickinson County Healthcare System | Nephrology | Current |
Accepting new patients |
| Dickinson County Healthcare System | Nephrology | Current |
Accepting new patients |
| MCHS Hospitals Inc | Current | 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
- marjorie.funtanilla.1@22710.direct.athenahealth.com
- marjorie.funtanilla@marshfieldclinichealthsystem.cernerdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | 4301071282 | MI | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110191045 | Other | MN | RR MEDICARE |
| 1102200711 | Other | MI | BCBS MI |
| 32482700 | Medicaid | WI | |
| 3498057 | Medicaid | MI |
Other providers in Iron Mountain, MI
- Bruce B. Franks
- David Frazier
- Sara Freeberg
- Kevin Jon Frievalt
- Brent Alan Fulks
- Bridget Jae Galas
- Angela Galeazzi
- John Michael Garrett
- Steven Ray Gartland I
- Haley Rae Gasperich
All providers in Iron Mountain, MI · Nephrology Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.