NPIMap

Individual provider Active NPI

John K Everett, D.O.

  • Family Medicine Physician
  • Indian River, MI
National Provider Identifier
1881628253
Registry record updated Feb 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101010086 Issued in MI
Practice address
6135 Cressy St
Indian River, MI 49749
Phone
(231) 238-8908
Fax
(231) 238-4419
NPI assigned
Jul 10, 2006
Last updated
Feb 2, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 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 5101010086 MI Primary

Addresses

Primary practice location

6135 Cressy St
Indian River, MI 49749

Mailing address

1035 W Washington Ave
Alpena, MI 49707-2929
Phone (989) 736-9815

Other identifiers 3

IdentifierTypeStateIssuer
2800120MedicaidMI
0151600015OtherMIINDIVIDUAL BLUE CROSS
700A610050OtherMIGROUP BLUE CROSS

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address john.everett.p1@direct.alcona.nextgenshare.com

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
I20100212000473 MI Practitioner - Family Practice 9638213762 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alcona Citizens for Health IncGroup PAC ID 5991691958, 65 clinicians

Practice addresses (Care Compare)

6135 Cressy St
Indian River, MI 49749-5151
Phone (231) 238-8908

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101010086MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Memorial Hospital Past Accepting new patients
Alcona Citizens for Health Inc Past Accepting new patients
Community Memorial Hospital Family Medicine Past Accepting new patients
Community Memorial Hospital Past Accepting new patients
Bay Street Orthopaedics PLLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: john.everett.p1@direct.alcona.nextgenshare.com

Organizations & group practices 6

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 4

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": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612224000000",
    "number": "1881628253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 W WASHINGTON AVE",
            "city": "ALPENA",
            "state": "MI",
            "postal_code": "497072929",
            "telephone_number": "989-736-9815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6135 CRESSY ST",
            "city": "INDIAN RIVER",
            "state": "MI",
            "postal_code": "49749",
            "telephone_number": "231-238-8908",
            "fax_number": "231-238-4419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVERETT",
        "first_name": "JOHN",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101010086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2800120",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL BLUE CROSS",
            "identifier": "0151600015",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP BLUE CROSS",
            "identifier": "700A610050",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "john.everett.p1@direct.alcona.nextgenshare.com",
            "affiliation": "N",
            "address_1": "6135 Cressy St",
            "city": "Indian River",
            "state": "MI",
            "country_code": "US",
            "postal_code": "49749",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Indian River, MI

Sources for this page

Verify at the official NPI Registry.