Morenci Medical Assoc PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

062948 Issued in MI

Legal business name

MORENCI MEDICAL ASSOC PC

Practice address

240 W Main St
Morenci, MI 49256-1455

Phone

(517) 458-6848

Fax

(517) 458-7614

NPI assigned

Oct 4, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Shivaprasad K Shetty, M.D.NPI 1235133190

Title

President

Phone

(517) 458-6848

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Morenci Medical Assoc, PC

  • Family Medicine Physician
  • Wauseon, OH
  • NPI 1962690735

  3870495849

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shivaprasad K Shetty, M.D.

  • Family Medicine Physician
  • Morenci, MI
  • NPI 1235133190

  MI

  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202256000000",
    "number": "1891983805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 W MAIN ST",
            "city": "MORENCI",
            "state": "MI",
            "postal_code": "492561455",
            "telephone_number": "517-458-6848",
            "fax_number": "517-458-7614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 W MAIN ST",
            "city": "MORENCI",
            "state": "MI",
            "postal_code": "492561455",
            "telephone_number": "517-458-6848",
            "fax_number": "517-458-7614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORENCI MEDICAL ASSOC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-04",
        "last_updated": "2008-02-06",
        "status": "A",
        "authorized_official_last_name": "SHETTY",
        "authorized_official_first_name": "SHIVAPRASAD",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "517-458-6848",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "062948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Morenci
• Family Medical Center of Michigan, Inc
• Family Medical Center of Michigan,Inc
• William J Gray, MD
• Highland Road Plaza LLC
• Carrie Murphy, BSW
• Jeffrey A. Robichaud, D.D.S.
• Lance Matthew Shaffer, D.C.
• Shivaprasad K Shetty, M.D.
• Rachel Lee Shoemaker

• All providers in Morenci, MI
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.