Kevin DO, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5101021949 Issued in MI

Practice address

Iha Lake Orion Primary Care
1375 S. Lapeer Rd Ste 210
Lake Orion, MI 48360

Phone

(248) 693-5700

Fax

(248) 693-5715

NPI assigned

Apr 13, 2015

Last updated

Nov 4, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Michigan State University College of Osteopathic Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Iha Ooma Primary LLCGroup PAC ID 7012316664, 45 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Trinity Health Oakland Hospital Hospital, Pontiac, MI, CCN 230029

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kdo2293389@direct.trinity-health.org

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.

• Iha Ooma Primary LLC

  dba IHA Bloomfield Primary Care

  • Family Medicine Physician
  • Bloomfield Township, MI
  • NPI 1245815984
  Medicare reassignment Care Compare group NPD
• Iha Ooma Primary LLC

  dba IHA Lake Orion Primary Care

  • Internal Medicine Physician
  • Lake Orion, MI
  • NPI 1316610769
  NPD
• Iha Ooma Primary LLC

  • Family Medicine Physician
  • Commerce TWP, MI
  • NPI 1780470179
  NPD
• Portland Adventist Medical Center

  dba Adventist Health Medical Group

  • Family Medicine Physician
  • Portland, OR
  • NPI 1750091021
  NPD (past)
• Walla Walla General Hospital

  dba Adventist Health Medical Group

  • Rural Health Clinic/Center
  • Walla Walla, WA
  • NPI 1992958771
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Joseph Mercy Hospital-SMHC

  dba St Joseph Mercy Oakland

  • General Acute Care Hospital
  • Pontiac, MI
  • NPI 1053356352
  Care Compare affiliation

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

{
    "created_epoch": "1428883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667520000000",
    "number": "1750777066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 FRANK LLOYD WRIGHT DRIVE",
            "address_2": "SUITE J2000",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48105",
            "telephone_number": "734-747-6766",
            "fax_number": "734-222-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "IHA LAKE ORION PRIMARY CARE",
            "address_2": "1375 S. LAPEER RD STE 210",
            "city": "LAKE ORION",
            "state": "MI",
            "postal_code": "48360",
            "telephone_number": "248-693-5700",
            "fax_number": "248-693-5715"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "831 NW Council Dr Ste 101",
            "address_purpose": "LOCATION",
            "city": "Gresham",
            "state": "OR",
            "postal_code": "970303722",
            "country_code": "US",
            "telephone_number": "503-665-8176",
            "fax_number": "503-665-8178",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DO",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-13",
        "last_updated": "2022-11-04",
        "certification_date": "2022-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101021949",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO194421",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Dickson, M.D.
• Patricia Anne Diener, MS, OTRL
• Sonja Leigh Dietz
• Sofia Isabela Diez
• Andrea Mary Dixon, OTR/L
• Ayden Michael Downey
• Rachel Elise Doyle, FNP-BC
• Melissa Lukens Drallos, PA
• Theresa Dray
• Andrea Kristina Dubiel, FNP-C

• Family Medicine Physician in Lake Orion, MI
• Providers in Lake Orion, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2022; 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.

Verify at the official NPI Registry.