Douglas Gregory Tacket, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5101012140 Issued in MI

Practice address

4077 S Cleveland Ave
Saint Joseph, MI 49085-9513

Phone

(269) 429-2992

NPI assigned

Jan 17, 2006

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

Other identifiers 5

Electronic endpoints 1

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

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Lakeland Medical PracticesGroup PAC ID 1658427042, 286 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Corewell Health Lakeland Hospitals St Joseph Hospital Home health agency, Benton Harbor, MI, CCN 237163
• Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021
• Corewell Health Watervliet Hospital Hospital, Watervliet, MI, CCN 230078

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dtacket1693712@epic00.corewelldirect.org
• Direct secure messaging: dtacket@mybeacon.cernerdirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lakeland Medical Practices

  • Internal Medicine Physician
  • Saint Joseph, MI
  • NPI 1538397120
  Medicare reassignment Care Compare group NPD
• Lakeland Medical Practices

  • Internal Medicine Physician
  • Bridgman, MI
  • NPI 1568232247
  NPD
• Niles Professional Services, Inc

  • Internal Medicine Physician
  • Niles, MI
  • NPI 1568407930
  NPD (past)

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

• Lakeland Community Hospital Watervliet

  • General Acute Care Hospital
  • Watervliet, MI
  • NPI 1700994845
  Care Compare affiliation
• Lakeland Hospitals at Niles and St Joseph, Inc

  • General Acute Care Hospital
  • Saint Joseph, MI
  • NPI 1134220031
  Care Compare affiliation
• Lakeland Hospitals at Niles and St Joseph, Inc

  • Home Health Agency
  • Benton Harbor, MI
  • NPI 1912094525
  Care Compare affiliation

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

{
    "created_epoch": "1137456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1790764868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4077 S CLEVELAND AVE",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4077 S CLEVELAND AVE",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859513",
            "telephone_number": "269-429-2992"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "206 W Warren St",
            "address_purpose": "LOCATION",
            "city": "Middlebury",
            "state": "IN",
            "postal_code": "465409410",
            "country_code": "US",
            "telephone_number": "574-825-2146",
            "fax_number": "574-524-7435",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TACKET",
        "first_name": "DOUGLAS",
        "middle_name": "GREGORY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-17",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02001246A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101012140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114560327",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0851101104",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "236040362",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300049695",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE  PTAN",
            "identifier": "236040362",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dtacket@mybeacon.cernerdirect.com",
            "affiliation": "N",
            "address_1": "206 W Warren St",
            "city": "Middlebury",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465409410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Richard T. Swanson, M.D.
• Justin Tyler Sybesma, M.D.
• Renata Sykula
• Dennis C Szymanski, M.D.
• T N B Family Counseling PLLC
• Karanvir Singh Takhar, DO
• Fa'Afesaga'I Talalima, CF-SLP
• Jessica Dawn Talonen, COTA
• Paul Kaling Tam, MD
• Hiu Tung Tang

• Family Medicine Physician in Saint Joseph, MI
• Providers in Saint Joseph, 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 Feb 22, 2024; 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.