NPIMap

Individual provider Active NPI

Brandy Eberhardt, DO

  • Family Medicine Physician
  • South Lyon, MI
National Provider Identifier
1871705129
Registry record updated Apr 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101016493 Issued in MI
Practice address
26006 Pontiac TRL
South Lyon, MI 48178-8050
Phone
(248) 437-5613
Fax
(248) 437-5694
NPI assigned
May 7, 2007
Last updated
Apr 1, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2011

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 5101016493 MI Primary

Addresses

Primary practice location

26006 Pontiac TRL
South Lyon, MI 48178-8050

Mailing address

26006 Pontiac TRL
South Lyon, MI 48178-8050
Phone (248) 437-5613

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
I20081204000505 MI Practitioner - Family Practice 2961563226 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Lyon Family Docs PCGroup PAC ID 6507035904, 2 clinicians

Practice addresses (Care Compare)

26006 Pontiac TRL
South Lyon, MI 48178-8050
Phone (248) 437-5613

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101016493MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Lyon Family Docs PC Family Medicine CurrentSince May 1, 2011 Accepting new patients

Locations

26006 Pontiac Trl
South Lyon, MI 48178
Phone (248) 437-5613

Interoperability endpoints

  • Direct secure messaging: beberhardt1125923@direct.hfhs.org
  • Direct secure messaging: beberhardt1232248@epic00.shdirect.org

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301616000000",
    "number": "1871705129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26006 PONTIAC TRL",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481788050",
            "telephone_number": "248-437-5613",
            "fax_number": "248-437-5694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26006 PONTIAC TRL",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481788050",
            "telephone_number": "248-437-5613",
            "fax_number": "248-437-5694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBERHARDT",
        "first_name": "BRANDY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-07",
        "last_updated": "2011-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101016493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Lyon, MI

Sources for this page

Verify at the official NPI Registry.