NPIMap

Individual provider Active NPI

Todd Edward Decker, MD

  • Family Medicine Physician
  • Petoskey, MI
National Provider Identifier
1871600676
Registry record updated Mar 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301079910 Issued in MI
Practice address
2325 Summit Park Dr
Suite 3
Petoskey, MI 49770-8774
Phone
(231) 439-5100
Fax
(231) 439-9292
NPI assigned
Aug 25, 2006
Last updated
Mar 8, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301079910 MI Primary

Addresses

Primary practice location

2325 Summit Park Dr
Suite 3
Petoskey, MI 49770-8774

Mailing address

2325 Summit Park Dr
Suite 3
Petoskey, MI 49770-8774
Phone (231) 439-5100

Other identifiers 2

IdentifierTypeStateIssuer
4831976MedicaidMI
0B41093OtherMIBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060210000056 MI Practitioner - Family Practice 3779598933 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bayside Family and Sports Medicine PCGroup PAC ID 6608881867, 4 clinicians

Practice addresses (Care Compare)

2325 Summit Park Dr
Suite 3
Petoskey, MI 49770-8774
Phone (231) 439-5100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions29
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301079910MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bayside Family & Sports Medicine PC Family Medicine CurrentSince Feb 6, 2006 Accepting new patients

Locations

2325 Summit Park Dr
Ste 3
Petoskey, MI 49770
Phone (231) 439-5100

Interoperability endpoints

  • Direct secure messaging: todddecker@bfsm.allscriptsdirect.net

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.

Hospital & facility affiliations 8

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": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615161600000",
    "number": "1871600676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2325 SUMMIT PARK DR",
            "address_2": "SUITE 3",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708774",
            "telephone_number": "231-439-5100",
            "fax_number": "231-439-9292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2325 SUMMIT PARK DR",
            "address_2": "SUITE 3",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708774",
            "telephone_number": "231-439-5100",
            "fax_number": "231-439-9292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECKER",
        "first_name": "TODD",
        "middle_name": "EDWARD",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2021-03-08",
        "certification_date": "2021-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301079910",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4831976",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0B41093",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petoskey, MI

Sources for this page

Verify at the official NPI Registry.