NPIMap

Organization Active NPI

Senior Medical Corp. P.C.

  • Geriatric Medicine (Family Medicine) Physician
  • Hesperia, MI
National Provider Identifier
1871677955
Registry record updated Feb 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
RT007455 Issued in MI
Legal business name
SENIOR MEDICAL CORP. P.C.
Practice address
3944 S Brenlor Dr
Hesperia, MI 49421-9585
Phone
(231) 854-2999
Fax
(231) 854-2998
NPI assigned
Oct 25, 2006
Last updated
Feb 13, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2012

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

Authorized official

Name
Dr. Raymond D Tracy, D.O.NPI 1588664064
Title
Medical Director
Phone
(231) 854-2999

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X RT007455 MI Primary

Addresses

Primary practice location

3944 S Brenlor Dr
Hesperia, MI 49421-9585

Mailing address

6087 E Filmore Rd
Walkerville, MI 49459-9344
Phone (231) 854-7655

Other identifiers 4

IdentifierTypeStateIssuer
P00694735OtherMIRAIL ROAD MEDICARE
P00232094OtherMIRAIL ROAD MEDICARE
4260509MedicaidMI
P00449750OtherMIRAIL ROAD MEDICARE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329091200000",
    "number": "1871677955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6087 E FILMORE RD",
            "city": "WALKERVILLE",
            "state": "MI",
            "postal_code": "494599344",
            "telephone_number": "231-854-7655",
            "fax_number": "231-854-2998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3944 S BRENLOR DR",
            "city": "HESPERIA",
            "state": "MI",
            "postal_code": "494219585",
            "telephone_number": "231-854-2999",
            "fax_number": "231-854-2998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR MEDICAL CORP. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2012-02-13",
        "status": "A",
        "authorized_official_last_name": "TRACY",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "231-854-2999",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "MI",
            "license": "RT007455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P00694735",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P00232094",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4260509",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P00449750",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hesperia, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2012; 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.