NPIMap

Individual provider Active NPI

Christian William Ertl, MD

  • Surgery Physician
  • Kalamazoo, MI
National Provider Identifier
1881691178
Registry record updated Feb 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
4301093343 Issued in MI
Practice address
1000 Oakland Dr
Kalamazoo, MI 49008-1282
Phone
(269) 337-6260
Fax
(269) 337-6530
NPI assigned
Jul 1, 2005
Last updated
Feb 15, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 4301093343 MI Primary

Addresses

Primary practice location

1000 Oakland Dr
Kalamazoo, MI 49008-1282

Mailing address

1000 Oakland Dr
Kalamazoo, MI 49008-1282
Phone (269) 337-6260

Other identifiers 12

IdentifierTypeStateIssuer
1881691178MedicaidMI
2386462OtherAETNA
149696OtherPREFERRED ONE HUSKY
010036846CT01OtherBC/BS
1417961137OtherMIBCBSM - BRONSON
03684601OtherCONNECTICARE
00136846501OtherBLUE CARE FAMILY PLAN
0V7800OtherHEALTHNET
P984485OtherOXFORD
020001475OtherMEDICARE
061596829OtherCIGNA HEALTH PLAN
1740406OtherUNITED HEALTHCARE

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
I20081103000653 MI Practitioner - General Surgery 8224197447 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
R Franklin University of Med & Sci/Chicago Medical School, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ascension Medical Group PromedGroup PAC ID 7315856077, 255 clinicians
Ascension Borgess Allegan HospitalGroup PAC ID 5092750356, shared by 7 NPIs, 17 clinicians

Practice addresses (Care Compare)

1717 Shaffer St
Kalamazoo, MI 49048-1647
Phone (269) 226-5290

551 Linn St
Allegan, MI 49010-1595
Phone (269) 686-4926

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair - groin (open)1-10
Removal of tissue1-10
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301093343MIMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Allegan, Inc Current Accepting new patients
Beacon Allegan, Inc CurrentSince Aug 17, 2021 Accepting new patients
Beacon Allegan, Inc CurrentSince Jan 1, 2026 Accepting new patients
Promed Healthcare CurrentSince Nov 6, 2016 Accepting new patients
Beacon Medical Group Michigan Inc Surgery Current Accepting new patients
Beacon Medical Group Michigan Inc CurrentSince Nov 6, 2016 Accepting new patients
Beacon Allegan, Inc CurrentSince Aug 17, 2021 Accepting new patients
Surgical Associates of Bristol PC Surgery Past Accepting new patients
Beacon Kalamazoo Inc Past Accepting new patients
Michigan State University Kalamazoo Center for Medical Studies Past Accepting new patients
Bristol Hospital Multi Specialty Group, Inc Surgery PastSince Apr 17, 2017 Accepting new patients

Locations

551 Linn St
Allegan, MI 49010
Phone (269) 686-5800

551 Linn St
Ste 250
Allegan, MI 49010

555 Linn St
Allegan, MI 49010
Phone (269) 673-8424

1717 Shaffer St
Kalamazoo, MI 49048
Phone (269) 226-5050

1722 Shaffer St
Kalamazoo, MI 49048
Phone (269) 226-5600

7901 Angling Rd
Portage, MI 49024
Phone (269) 324-8405

Interoperability endpoints

  • Direct secure messaging: christian.ertl.p1@direct.alleganfamilyhealth.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 12

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": "1120176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329264000000",
    "number": "1881691178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 OAKLAND DR",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490081282",
            "telephone_number": "269-337-6260",
            "fax_number": "269-337-6441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 OAKLAND DR",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490081282",
            "telephone_number": "269-337-6260",
            "fax_number": "269-337-6530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERTL",
        "first_name": "CHRISTIAN",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-01",
        "last_updated": "2012-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301093343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881691178",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2386462",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE HUSKY",
            "identifier": "149696",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "010036846CT01",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM - BRONSON",
            "identifier": "1417961137",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE",
            "identifier": "03684601",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE FAMILY PLAN",
            "identifier": "00136846501",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "0V7800",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P984485",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "020001475",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA HEALTH PLAN",
            "identifier": "061596829",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1740406",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.