NPIMap

Organization Active NPI

Brian T. Gietzen, M. D., P. C.

Doing business as Legacy Medical Group

  • Internal Medicine Physician
  • Rochester Hills, MI
National Provider Identifier
1902023641
Registry record updated Oct 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
BRIAN T. GIETZEN, M. D., P. C.
Doing business as
Legacy Medical Group
Practice address
1460 Walton Blvd
Suite 200
Rochester Hills, MI 48309-1768
Phone
(248) 650-1800
Fax
(248) 650-1856
NPI assigned
Apr 20, 2007
Last updated
Oct 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2020

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

Authorized official

Name
Dr. Brian T Gietzen, M.D.NPI 1639154263
Title
Owner Medical Director
Phone
(248) 650-1800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 4301070159 MI
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1460 Walton Blvd
Suite 200
Rochester Hills, MI 48309-1768

Mailing address

1460 Walton Blvd
Suite 200
Rochester Hills, MI 48309-1768
Phone (248) 650-1800

Other names 1

  • Legacy Medical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050922000379 MI Part B Supplier - Clinic/Group Practice 0840224564 Receives reassigned benefits from 12 practitioners
Practice locations: Rochester Hills, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602720000000",
    "number": "1902023641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1460 WALTON BLVD",
            "address_2": "SUITE 200",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483091768",
            "telephone_number": "248-650-1800",
            "fax_number": "248-650-1856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 WALTON BLVD",
            "address_2": "SUITE 200",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483091768",
            "telephone_number": "248-650-1800",
            "fax_number": "248-650-1856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIAN T. GIETZEN, M. D., P. C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A",
        "authorized_official_last_name": "GIETZEN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER  MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "248-650-1800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301070159",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rochester Hills, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; 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.

Verify at the official NPI Registry.