University Medical Specialties, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

DR064962 Issued in MI

Legal business name

UNIVERSITY MEDICAL SPECIALTIES, PC

Practice address

9045 US Highway 31
Berrien Springs, MI 49103-1804

Phone

(269) 473-2222

Fax

(269) 473-6880

NPI assigned

Nov 9, 2007

Organization subpart

No

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

Authorized official

Name

Raeann Danene Long

Title

Office Manager

Phone

(269) 473-2222

Specialties & licenses 7

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1194566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224115200000",
    "number": "1902086689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9045 US HIGHWAY 31",
            "city": "BERRIEN SPRINGS",
            "state": "MI",
            "postal_code": "491031804",
            "telephone_number": "269-473-2222",
            "fax_number": "269-473-6880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9045 US HIGHWAY 31",
            "city": "BERRIEN SPRINGS",
            "state": "MI",
            "postal_code": "491031804",
            "telephone_number": "269-473-2222",
            "fax_number": "269-473-6880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY MEDICAL SPECIALTIES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-09",
        "last_updated": "2008-10-16",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "RAEANN",
        "authorized_official_middle_name": "DANENE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "269-473-2222"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MI",
            "license": "LH009414",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MI",
            "license": "FK271098",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MI",
            "license": "NC007536",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "DR064962",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "LH052398",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "KK081055",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "KK081055",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MENTAL HEALTH BCBSM PIN",
            "identifier": "680A112130",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL GROUP BCBSM PIN",
            "identifier": "700A146860",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Wellviewspring Group PLLC (Judith Fisher, Psy.D.)
• Marvelyn Elfreda Thompson, NP
• Yulian A. Tinoco, MA, LLC
• Betty W. Ulmanis, LMT, CMMMT, NCTMB
• University Family Dentistry
• Valerie Annette Van Allen
• Emmanuel Victorin
• Dennis Edwin Waite, ED.D.
• Lorren Wiedemann
• Jillian Wiesemes

• Family Medicine Physician in Berrien Springs, MI
• Providers in Berrien Springs, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.