Individual provider Active NPI

Chuck Yadmark, MD

  • Internal Medicine Physician
  • Livonia, MI
National Provider Identifier
1891803029
Registry record updated Oct 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
CY063359 Issued in MI
Practice address
31610 Plymouth Rd
Livonia, MI 48150-1930
Phone
(734) 421-2840
Fax
(734) 421-4045
NPI assigned
Aug 28, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X CY063359 MI Primary

Addresses

Primary practice location

31610 Plymouth Rd
Livonia, MI 48150-1930

Mailing address

31610 Plymouth Rd
Livonia, MI 48150-1932
Phone (734) 421-2840

Other identifiers 3

IdentifierTypeStateIssuer
CY063359OtherMISTATE LICENSE
080H24860OtherMIBLUE CROSS BLUE SHIELD
383344395OtherMITAX ID

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051220000787 MI Practitioner - Internal Medicine 1456373398 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Michigan Medical School, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iha Health Services CorporationGroup PAC ID 2466351440, 1,149 clinicians

Practice addresses (Care Compare)

31610 Plymouth Rd
Livonia, MI 48150-1930
Phone (734) 421-2840

4350 Jackson Rd
Suite 230
Ann Arbor, MI 48103-1890
Phone (734) 887-4396

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
CY063359MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Health Service Corporation CurrentSince Oct 6, 2018 Accepting new patients
Iha Health Services Corporation CurrentSince Oct 6, 2018 Accepting new patients
Iha Health Services Corporation Current Accepting new patients

Locations

4350 Jackson Rd
Ste 230
Ann Arbor, MI 48103
Phone (734) 887-4396

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

2305 Genoa Business Park Dr
Ste 200
Brighton, MI 48114
Phone (810) 494-6840

128 Van Buren St
Chelsea, MI 48118
Phone (734) 475-8677

1255 E M 36
Pinckney, MI 48169
Phone (734) 878-1000

44428 Woodward Ave
Ste 102
Pontiac, MI 48341
Phone (734) 712-8700

Interoperability endpoints

  • Direct secure messaging: cyadmark206105@direct.trinity-health.org

Organizations & group practices 4

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.

Hospital & facility affiliations 2

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": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697500800000",
    "number": "1891803029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31610 PLYMOUTH RD",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481501932",
            "telephone_number": "734-421-2840",
            "fax_number": "734-421-4045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31610 PLYMOUTH RD",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481501930",
            "telephone_number": "734-421-2840",
            "fax_number": "734-421-4045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YADMARK",
        "first_name": "CHUCK",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-28",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "CY063359",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "CY063359",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "080H24860",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "383344395",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Livonia, MI

Sources for this page

Verify at the official NPI Registry.