Individual provider Active NPI

Kerent Dominique Pihl, D.O.

  • Surgery Physician
  • Wyoming, MI
National Provider Identifier
1902104029
Registry record updated Jul 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
5101019176 Issued in MI
Practice address
1009 44TH St SW
Ste 101
Wyoming, MI 49509-4480
Phone
(616) 828-4622
Fax
(616) 635-2552
NPI assigned
Mar 14, 2011
Last updated
Jul 6, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 6, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 5101019176 MI Primary

Addresses

Primary practice location

1009 44TH St SW
Ste 101
Wyoming, MI 49509-4480

Mailing address

1009 44TH St SW
Ste 101
Wyoming, MI 49509-4480
Phone (616) 828-4622

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
I20160531002071 MI Practitioner - General Surgery 8224328430 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Michigan State University College of Osteopathic Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1009 44TH St SW
Suite 101
Wyoming, MI 49509-4480
Phone (616) 828-4622

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy11
Hernia repair - groin (open)11
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101019176MIMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sparrow Carson Hospital CurrentSince Aug 1, 2016 Accepting new patients
Grand Rapids Surgical Associates, PLLC Surgery CurrentSince Mar 24, 2016 Accepting new patients
Sparrow Carson Hospital Current Accepting new patients
Sparrow Carson Hospital Surgery CurrentSince Aug 1, 2016 Accepting new patients

Locations

8175 Reliable Pkwy
Chicago, IL 60686

102 S 3rd St
Ste 400
Carson City, MI 48811
Phone (989) 584-3142

406 E Elm St
Carson City, MI 48811
Phone (517) 584-3131

423 E Main St
Ste B
Carson City, MI 48811
Phone (989) 584-6320

1009 44th St SW
Ste 101
Wyoming, MI 49509
Phone (616) 828-4622

Interoperability endpoints

  • Direct secure messaging: kpihl64582@direct.metrohealth.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1300060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467763200000",
    "number": "1902104029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1009 44TH ST SW",
            "address_2": "STE 101",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495094480",
            "telephone_number": "616-828-4622",
            "fax_number": "616-635-2552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 44TH ST SW",
            "address_2": "STE 101",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495094480",
            "telephone_number": "616-828-4622",
            "fax_number": "616-635-2552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PIHL",
        "first_name": "KERENT",
        "middle_name": "DOMINIQUE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-03-14",
        "last_updated": "2016-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "5101019176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyoming, MI

Sources for this page

Verify at the official NPI Registry.