NPIMap

Organization Active NPI

Integrated Physical Medicine PLLC

  • Family Medicine Physician
  • Rockford, MI
National Provider Identifier
1790067015
Registry record updated Sep 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301059449 Issued in MI
Legal business name
INTEGRATED PHYSICAL MEDICINE PLLC
Practice address
6769 Courtland Dr NE
Suite 100
Rockford, MI 49341-7242
Phone
(616) 863-9482
Fax
(616) 863-9486
NPI assigned
Sep 13, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2011

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

Authorized official

Name
Erik Daniel Stanton
Title
General Manager
Phone
(616) 863-9482

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 4301059449 MI Primary

Addresses

Primary practice location

6769 Courtland Dr NE
Suite 100
Rockford, MI 49341-7242

Mailing address

6769 Courtland Dr NE
Suite 100
Rockford, MI 49341-7242
Phone (616) 863-9482

National Provider Directory

National Provider Directory

Locations

6769 Courtland Dr NE
Ste 100
Rockford, MI 49341
Phone (616) 433-6857

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1315872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315872000000",
    "number": "1790067015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6769 COURTLAND DR NE",
            "address_2": "SUITE 100",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "493417242",
            "telephone_number": "616-863-9482",
            "fax_number": "616-863-9486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6769 COURTLAND DR NE",
            "address_2": "SUITE 100",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "493417242",
            "telephone_number": "616-863-9482",
            "fax_number": "616-863-9486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED PHYSICAL MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-13",
        "last_updated": "2011-09-13",
        "status": "A",
        "authorized_official_last_name": "STANTON",
        "authorized_official_first_name": "ERIK",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "616-863-9482"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301059449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.