Individual provider Active NPI

Gyl A. Kasewurm, AUD, FAAA

  • Audiologist
  • Saint Joseph, MI
National Provider Identifier
1811991771
Registry record updated Oct 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
1601000002 Issued in MI
Practice address
511 Renaissance Dr
Ste 100
Saint Joseph, MI 49085-2180
Phone
(269) 982-3444
Fax
(269) 982-3445
NPI assigned
Jun 9, 2005
Last updated
Oct 12, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 1601000002 MI Primary

Addresses

Primary practice location

511 Renaissance Dr
Ste 100
Saint Joseph, MI 49085-2180

Mailing address

511 Renaissance Dr
Ste 100
Saint Joseph, MI 49085-2180
Phone (269) 982-3444

Other identifiers 2

IdentifierTypeStateIssuer
901870694MedicaidMI
804989111MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111205000048 MI Practitioner - Qualified Audiologist 6305011289 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Hearing Services, LTD Audiologist CurrentSince Dec 5, 2011 Accepting new patients

Locations

511 Renaissance Dr
Ste 100
Saint Joseph, MI 49085
Phone (269) 982-3444

Organizations & group practices 1

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": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318377600000",
    "number": "1811991771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 RENAISSANCE DR",
            "address_2": "STE 100",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490852180",
            "telephone_number": "269-982-3444",
            "fax_number": "269-982-3445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 RENAISSANCE DR",
            "address_2": "STE 100",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490852180",
            "telephone_number": "269-982-3444",
            "fax_number": "269-982-3445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASEWURM",
        "first_name": "GYL",
        "middle_name": "A.",
        "name_prefix": "Mrs.",
        "credential": "AUD, FAAA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-09",
        "last_updated": "2011-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MI",
            "license": "1601000002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "901870694",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "804989111",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.