Otsego Family Medical Practice, PLLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704142595 Issued in MI

Legal business name

OTSEGO FAMILY MEDICAL PRACTICE, PLLC

Practice address

34471 North Dr
Gobles, MI 49055-9670

Phone

(269) 628-2789

NPI assigned

Mar 15, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Fred D Boothby, CNP

Title

Owner

Phone

(269) 628-4997

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Patrick J Dougherty, PA C

  • Physician Assistant
  • Highlands Ranch, CO
  • NPI 1285625590
  NPD (past)
• Susan Mathews, M D

  • Adolescent Medicine (Family Medicine) Physician
  • Salt Lake City, UT
  • NPI 1073733689
  NPD (past)

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801920533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34471 NORTH DR",
            "city": "GOBLES",
            "state": "MI",
            "postal_code": "490559670",
            "telephone_number": "269-628-2789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34471 NORTH DR",
            "city": "GOBLES",
            "state": "MI",
            "postal_code": "490559670",
            "telephone_number": "269-628-2789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTSEGO FAMILY MEDICAL PRACTICE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOOTHBY",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-628-4997",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704142595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Metuschelah Munyabera
• Murks Village Market Inc (Gobles Village Market Pharmacy)
• Murks Village Market Inc (Gobles Village Market Pharmacy)
• New Found Hope, LLC
• Joseph John-Moynihan Olsiewicz
• Monica Lee Phillips, OTRL
• Arthur Pruitt, LLPC
• Andrew Rajzer, LMSW
• Kathleen Richards-Allen, LMT, NTP
• Ruth Robb

• Family Nurse Practitioner in Gobles, MI
• Providers in Gobles, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.