East Bay Medical Center, P.C.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

4704203066 Issued in MI

Legal business name

EAST BAY MEDICAL CENTER, P.C.

Practice address

1401 Short Dr
Prudenville, MI 48651-8436

Phone

(989) 366-1515

Fax

(989) 366-1501

NPI assigned

Jul 10, 2007

Last updated

Jun 12, 2013By 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

Suzanne Alaine Blanchard, NPNPI 1023015104

Title

Owner

Phone

(989) 366-1515

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/22781/brand/1/csg/1/fhir/r4

Practitioners 1

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.

• Suzanne A Blanchard, NP

  • Primary Care Nurse Practitioner
  • Prudenville, MI
  • NPI 1023015104
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370995200000",
    "number": "1851599054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19",
            "address_2": "1401 SHORT DRIVE",
            "city": "PRUDENVILLE",
            "state": "MI",
            "postal_code": "486518436",
            "telephone_number": "989-366-1515",
            "fax_number": "989-366-1501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 SHORT DR",
            "city": "PRUDENVILLE",
            "state": "MI",
            "postal_code": "486518436",
            "telephone_number": "989-366-1515",
            "fax_number": "989-366-1501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST BAY MEDICAL CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-10",
        "last_updated": "2013-06-12",
        "status": "A",
        "authorized_official_last_name": "BLANCHARD",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_middle_name": "ALAINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-366-1515",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MI",
            "license": "4704203066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4577440",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5008702190",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brigitte Diane Doehring
• Victor Luis Dominguez, M.D.
• Riley Joseph Dotson
• Reine Driscoll-Grammatico
• Ilamae Elizabeth Dyer
• Relicious N Eboh
• Anna Evans
• Jacob Dylan Evans
• Shelbi Shiann Evans
• Deanna Marie Fasbender

• Primary Care Clinic/Center in Prudenville, MI
• Providers in Prudenville, MI by specialty
• Primary Care Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.