Active NPI
Brent S. Lotterman, PA-C
- Physician Assistant
- Port Huron, MI
National Provider Identifier
1881889053
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601005146
- Practice address
- 2611 Electric Ave
Suite E
Port Huron, MI 48060-6587 - Phone
- (810) 987-9871
- NPI assigned
- Sep 11, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601005146 | MI | Primary |
Addresses
Primary practice location
2611 Electric Ave
Suite E
Port Huron, MI 48060-6587
Mailing address
2611 Electric Ave
Suite E
Port Huron, MI 48060-6587
Phone (810) 987-9871
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1555 S Blvd E
Rochester Hills, MI 48307-5624
Phone (248) 215-8080
44201 Dequindre Rd
Troy, MI 48085-1117
Phone (248) 964-5000
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601005146 | MI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellstreet Urgent Care of Michigan | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Orthopaedic Surgery Physician
- Rochester Hills, MI
- NPI 1972868321
-
- Urgent Care Clinic/Center
- West Bloomfield, MI
- NPI 1578048096
-
- Non-Pharmacy Dispensing Site
- Troy, MI
- NPI 1649952052
Hospital & facility affiliations 12
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Farmington Hills, MI
- NPI 1336183367
-
- General Acute Care Hospital
- Troy, MI
- NPI 1306825997
-
- General Acute Care Hospital
- Royal Oak, MI
- NPI 1689653305
-
- Hospitalist Physician
- Royal Oak, MI
- NPI 1811044878
-
- General Acute Care Hospital
- Grosse Pointe, MI
- NPI 1932396017
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189468800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231286400000",
"number": "1881889053",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2611 ELECTRIC AVE",
"address_2": "SUITE E",
"city": "PORT HURON",
"state": "MI",
"postal_code": "480606587",
"telephone_number": "810-987-9871"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2611 ELECTRIC AVE",
"address_2": "SUITE E",
"city": "PORT HURON",
"state": "MI",
"postal_code": "480606587",
"telephone_number": "810-987-9871"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOTTERMAN",
"first_name": "BRENT",
"middle_name": "S.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-09-11",
"last_updated": "2009-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601005146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Huron, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.