Active NPI
Marc B Renner, M.D.
- Diagnostic Radiology Physician
- Ann Arbor, MI
National Provider Identifier
1730180001
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 4301406728
- Practice address
- 705 N 5TH Ave
Ann Arbor, MI 48104-1006 - Phone
- (734) 645-6206
- NPI assigned
- Aug 9, 2005
- Last updated
- Nov 5, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 4301406728 | MI | Primary |
Addresses
Primary practice location
705 N 5TH Ave
Ann Arbor, MI 48104-1006
Mailing address
705 N 5TH Ave
Ann Arbor, MI 48104-1006
Phone (734) 645-6206
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300020174 | Other | RAILROAD MEDICARE | |
| 3103898601 | Other | MI | BCBS OF MICHIGAN |
| 2642906 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jackson Radiology Consultants, P C | Diagnostic Radiology | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Diagnostic Radiology Physician
- Jackson, MI
- NPI 1295736015
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446681600000",
"number": "1730180001",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "705 N 5TH AVE",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481041006",
"telephone_number": "734-645-6206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "705 N 5TH AVE",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481041006",
"telephone_number": "734-645-6206"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENNER",
"first_name": "MARC",
"middle_name": "B",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-09",
"last_updated": "2015-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "MI",
"license": "4301406728",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "300020174",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MICHIGAN",
"identifier": "3103898601",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2642906",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2015; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.