Individual provider Active NPI

Austin Edward Ford, DO

  • Emergency Medicine Physician
  • Grand Blanc, MI
National Provider Identifier
1790570133
Registry record updated May 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
5151018148 Issued in MI
Practice address
1 Genesys Pkwy # Mi48439
Grand Blanc, MI 48439-8065
Phone
(810) 606-5000
NPI assigned
Apr 14, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2026

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 5151018148 MI Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1 Genesys Pkwy # Mi48439
Grand Blanc, MI 48439-8065

Mailing address

64 Robbins St
Waterbury, CT 06708-2600
Phone (203) 573-7257

Other practice location 1

64 Robbins St
Waterbury, CT 06708-2600
Phone (203) 573-7257

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20250625001348 CT Order and Referring Only - General SurgeryPractitioner - General Surgery 6305358375

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5151018148MIMDEmergency Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1744588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779753600000",
    "number": "1790570133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64 ROBBINS ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082600",
            "telephone_number": "203-573-7257",
            "fax_number": "203-573-6073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GENESYS PKWY # MI48439",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484398065",
            "telephone_number": "810-606-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "64 Robbins St",
            "address_purpose": "LOCATION",
            "city": "Waterbury",
            "state": "CT",
            "postal_code": "067082600",
            "country_code": "US",
            "telephone_number": "203-573-7257",
            "fax_number": "203-573-6073",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORD",
        "first_name": "AUSTIN",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-14",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5151018148",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Blanc, MI

Sources for this page

Verify at the official NPI Registry.