Active NPI
Great Lakes Radiology Services
- Diagnostic Radiology Physician
- Plymouth, MI
National Provider Identifier
1891529111
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- Legal business name
- GREAT LAKES RADIOLOGY SERVICES
- Practice address
- 729 W Ann Arbor TRL Ste 2
Plymouth, MI 48170-6225 - Phone
- (734) 673-3764
- NPI assigned
- Aug 28, 2024
- Last updated
- Oct 17, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Brian Madison
- Title
- Organizer
- Phone
- (734) 673-3764
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | NU | Primary |
Addresses
Primary practice location
729 W Ann Arbor TRL Ste 2
Plymouth, MI 48170-6225
Mailing address
729 W Ann Arbor TRL Ste 2
Plymouth, MI 48170-6225
Phone (734) 673-3764
Other practice location 1
4501 Bruce B Downs BLVD
Wesley Chapel, FL 33544-9216
Phone (813) 914-1000
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://cpiapigateway.cms.gov/api/esmdf/ext/v1/fhir/Practitioner/ | Other | Management Services Network, LLC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI, OH, UT, CA, IL, PA, AZ, FL, NY, TX, NH, MO, KS, MA, GA, SC, MN
Enrollment records 17
National Provider Directory
National Provider DirectoryLocations
4501 Bruce B Downs Blvd
Zephyrhills, FL 33544
Phone (813) 870-4000
729 W Ann Arbor Trl
Ste 2
Plymouth, MI 48170
Phone (734) 673-3764
1121 Chambers Rd
223
Columbus, OH 43212
1121 Chambers Rd
223
Columbus, OH 43212
Practitioners & affiliated clinicians
Practitioners 52
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Diagnostic Radiology Physician
- Garden City, MI
- NPI 1306188081
-
- Vascular & Interventional Radiology Physician
- Royal Oak, MI
- NPI 1083746671
Diagnostic Radiology
-
- Diagnostic Radiology Physician
- Ann Arbor, MI
- NPI 1861703589
-
- Diagnostic Radiology Physician
- Royal Oak, MI
- NPI 1083674071
-
- Diagnostic Radiology Physician
- Northville, MI
- NPI 1902034663
-
- Diagnostic Radiology Physician
- Port Huron, MI
- NPI 1033121892
-
- Diagnostic Radiology Physician
- Orlando, FL
- NPI 1992141295
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724803200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1792195200000",
"number": "1891529111",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "729 W ANN ARBOR TRL STE 2",
"city": "PLYMOUTH",
"state": "MI",
"postal_code": "481706225",
"telephone_number": "734-673-3764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "729 W ANN ARBOR TRL STE 2",
"city": "PLYMOUTH",
"state": "MI",
"postal_code": "481706225",
"telephone_number": "734-673-3764"
}
],
"practiceLocations": [
{
"address_1": "4501 Bruce B Downs BLVD",
"address_purpose": "LOCATION",
"city": "Wesley Chapel",
"state": "FL",
"postal_code": "335449216",
"country_code": "US",
"telephone_number": "813-914-1000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "GREAT LAKES RADIOLOGY SERVICES",
"organizational_subpart": "NO",
"enumeration_date": "2024-08-28",
"last_updated": "2026-10-17",
"certification_date": "2026-10-17",
"status": "A",
"authorized_official_last_name": "MADISON",
"authorized_official_first_name": "BRIAN",
"authorized_official_title_or_position": "ORGANIZER",
"authorized_official_telephone_number": "734-673-3764"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://cpiapigateway.cms.gov/api/esmdf/ext/v1/fhir/Practitioner/",
"affiliation": "Y",
"endpointDescription": "urn:oid:2.16.840.1.113883.3.1036.1",
"affiliationName": "Management Services Network, LLC",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "2357 Warm Springs Rd Ste 400",
"city": "Columbus",
"state": "GA",
"country_code": "US",
"postal_code": "319046874",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Plymouth, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.