Individual provider Active NPI

Katherine J Pitus, DO

  • Emergency Medicine Physician
  • Warren, MI
National Provider Identifier
1760493472
Registry record updated Apr 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
5101011465 Issued in MI
Practice address
118000 E Twelve Mile Rd
ER Department
Warren, MI 48093
Phone
(586) 573-5028
NPI assigned
Aug 10, 2006
Last updated
Apr 18, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 5101011465 MI Primary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X KP011465 MI

Addresses

Primary practice location

118000 E Twelve Mile Rd
ER Department
Warren, MI 48093

Mailing address

PO Box 67000
Dept 285301
Detroit, MI 48267-2853
Phone (800) 540-8739

Other identifiers 1

IdentifierTypeStateIssuer
113194570MedicaidMI

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20100728000692 MI Practitioner - Emergency Medicine 7012040066 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101011465MIMDEmergency Medicine Physician
KP011465MIMDEmergency Medical Services (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Observation Emergency Physicians, P.C. Emergency Medicine CurrentSince Oct 1, 2012 Accepting new patients
St John Macomb-Oakland Hospital Emergency Medical Services Past Accepting new patients

Locations

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

11800 E 12 Mile Rd
Warren, MI 48093
Phone (586) 573-5000

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.

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681776000000",
    "number": "1760493472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 67000",
            "address_2": "DEPT 285301",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482672853",
            "telephone_number": "800-540-8739",
            "fax_number": "616-975-9827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118000 E TWELVE MILE RD",
            "address_2": "ER DEPARTMENT",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "48093",
            "telephone_number": "586-573-5028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PITUS",
        "first_name": "KATHERINE",
        "middle_name": "J",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-10",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101011465",
            "primary": true
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "MI",
            "license": "KP011465",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113194570",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

Verify at the official NPI Registry.