Individual provider Active NPI

Mary J Fillmore, ANP

  • Adult Health Nurse Practitioner
  • Kalamazoo, MI
National Provider Identifier
1821316837
Registry record updated Aug 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
4704224949 Issued in MI
Practice address
1521 Gull Rd
Kalamazoo, MI 49048-1640
Phone
(269) 226-5074
NPI assigned
May 14, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 30, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 209008161 IL
Adult Health Nurse Practitioner 363LA2200X 4704224949 MI Primary

Addresses

Primary practice location

1521 Gull Rd
Kalamazoo, MI 49048-1640

Mailing address

721 S Wilmott St
Otsego, MI 49078-1448
Phone (630) 730-3898

Other practice location 1

601 John St # 74
Kalamazoo, MI 49007-5341
Phone (269) 341-8481

Other names 1

  • Mary J Dorencz Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.bronsonhg.org Direct Bronson Healthcare Group

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151215002041 MI Practitioner - Nurse Practitioner 5890956577 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bronson Battle Creek HospitalGroup PAC ID 0547173478, 187 clinicians
Bronson Methodist HospitalGroup PAC ID 0244148633, 721 clinicians

Practice addresses (Care Compare)

300 N Ave
Battle Creek, MI 49017-3307
Phone (269) 245-8446

601 John St
Kalamazoo, MI 49007-5377

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.43 of 100Reported as group
Quality
75.38
Promoting interoperability
100
Improvement activities
40
Cost
79.38

Merit-based Incentive Payment System (MIPS)

Final score
87.91 of 100Reported as group
Quality
83.03
Promoting interoperability
100
Improvement activities
40
Cost
76.65

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704224949MIMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group Promed CurrentSince Nov 23, 2015 Accepting new patients
Bronson Battle Creek Hospital CurrentSince Mar 12, 2024 Accepting new patients
Bronson Methodist Hospital CurrentSince Sep 1, 2023 Accepting new patients
Ascension Medical Group Promed Current Accepting new patients
Bronson Battle Creek Hospital CurrentSince Mar 12, 2024 Accepting new patients
Promed Healthcare CurrentSince Nov 23, 2015 Accepting new patients

Locations

300 North Ave
Fl 2
Battle Creek, MI 49017
Phone (269) 245-5862

300 North Ave
Ste B3366
Battle Creek, MI 49017
Phone (269) 245-8446

601 John St
Kalamazoo, MI 49007
Phone (269) 341-7100

601 John St
#74
Kalamazoo, MI 49007
Phone (269) 341-8481

1521 Gull Rd
Kalamazoo, MI 49048
Phone (269) 226-5165

601 John St
Ste M-124
Kalamazoo, MI 49007
Phone (269) 341-7500

7901 Angling Rd
Portage, MI 49024
Phone (269) 324-8405

Interoperability endpoints

  • Direct secure messaging: direct@direct.bronsonhg.org

Organizations & group practices 6

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1273795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693353600000",
    "number": "1821316837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 S WILMOTT ST",
            "city": "OTSEGO",
            "state": "MI",
            "postal_code": "490781448",
            "telephone_number": "630-730-3898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 GULL RD",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490481640",
            "telephone_number": "269-226-5074"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 John St # 74",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490075341",
            "country_code": "US",
            "telephone_number": "269-341-8481",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FILLMORE",
        "first_name": "MARY",
        "middle_name": "J",
        "credential": "ANP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-05-14",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209008161",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MI",
            "license": "4704224949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson Healthcare Group Direct address",
            "affiliationName": "Bronson Healthcare Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "DORENCZ",
            "middle_name": "J",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.