NPIMap

Individual provider Active NPI

Bryant T Ittiara, D.O.

  • Interventional Pain Medicine Physician
  • Allen Park, MI
National Provider Identifier
1871829069
Registry record updated Jan 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
5101017919 Issued in MI
Practice address
18707 Ecorse Rd
Allen Park, MI 48101-2255
Phone
(734) 682-3309
Fax
(734) 682-1488
NPI assigned
Oct 23, 2009
Last updated
Jan 7, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 7, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X L1593593 MI
Pain Medicine (Anesthesiology) Physician 207LP2900X 5101017919 MI
Interventional Pain Medicine Physician 208VP0014X 5101017919 MI Primary

Addresses

Primary practice location

18707 Ecorse Rd
Allen Park, MI 48101-2255

Mailing address

416 James Cir
Royal Oak, MI 48067-4545
Phone (734) 604-0017

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
I20131003000541 MI Practitioner - Pain Management 3971747908 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pain Management
Education
Lake Erie College of Osteopathic Medicine, Erie, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Physician Care Solutions PCGroup PAC ID 3678903465, 23 clinicians

Practice addresses (Care Compare)

101 W Big Beaver Rd
Suite 1400
Troy, MI 48084-5295
Phone (586) 343-1022

1030 N Monroe St
Monroe, MI 48162-3113
Phone (734) 682-3309

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L1593593MIMDAnesthesiology Physician
5101017919MIMDInterventional Pain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Care Solutions P.C. CurrentSince Jan 25, 2025 Accepting new patients
Neurological Institute of Interventional Pain Management PLLC CurrentSince Oct 15, 2015 Accepting new patients
Ambulatory Anesthesia Associates, PC Anesthesiology CurrentSince Feb 4, 2017 Accepting new patients
Interventional Pain & Anesthesia Consultants PLLC Pain Medicine Past Accepting new patients
Anesthesia Consultants of Michigan, PLLC Anesthesiology Past Accepting new patients

Locations

18707 Ecorse Rd
Allen Park, MI 48101
Phone (734) 682-3309

1030 N Monroe St
Monroe, MI 48162
Phone (734) 682-3309

101 W Big Beaver Rd
Ste 1400
Troy, MI 48084
Phone (248) 687-1829

230 W Maple Rd
Troy, MI 48084
Phone (248) 244-1500

11650 Belleville Rd
Ste 105
Van Buren Township, MI 48111
Phone (734) 325-6282

Organizations & group practices 5

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 3

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": "1256256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546819200000",
    "number": "1871829069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 JAMES CIR",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480674545",
            "telephone_number": "734-604-0017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18707 ECORSE RD",
            "city": "ALLEN PARK",
            "state": "MI",
            "postal_code": "481012255",
            "telephone_number": "734-682-3309",
            "fax_number": "734-682-1488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ITTIARA",
        "first_name": "BRYANT",
        "middle_name": "T",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-10-23",
        "last_updated": "2019-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "L1593593",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "MI",
            "license": "5101017919",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "MI",
            "license": "5101017919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Allen Park, MI

Sources for this page

Verify at the official NPI Registry.