Active NPI
Reginald J Eadie, M.D.
- Emergency Medical Services (Emergency Medicine) Physician
- Detroit, MI
National Provider Identifier
1902866734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medical Services (Emergency Medicine) Physician
- License
- 4301065909
- Practice address
- 6071 W Outer Dr
Detroit, MI 48235-2624 - Phone
- (313) 745-2780
- Fax
- (313) 745-1520
- NPI assigned
- Mar 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medical Services (Emergency Medicine) Physician | 207PE0004X | 4301065909 | MI | Primary |
| General Practice Physician | 208D00000X | 4301065909 | MI |
Addresses
Primary practice location
6071 W Outer Dr
Detroit, MI 48235-2624
Mailing address
6940 Kennesaw Rd
Canton, MI 48187-1283
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 104184200 | Medicaid | MI | |
| 104205660 | Medicaid | MI | |
| RE065909 | Other | MI | BC/BS OF MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301065909 | MI | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DMC Orthopedic Billing Associates LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Orthopaedic Surgery Physician
- Detroit, MI
- NPI 1457387607
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234915200000",
"number": "1902866734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6940 KENNESAW RD",
"city": "CANTON",
"state": "MI",
"postal_code": "481871283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6071 W OUTER DR",
"city": "DETROIT",
"state": "MI",
"postal_code": "482352624",
"telephone_number": "313-745-2780",
"fax_number": "313-745-1520"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EADIE",
"first_name": "REGINALD",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-24",
"last_updated": "2009-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "207PE0004X",
"taxonomy_group": "",
"desc": "Emergency Medicine, Emergency Medical Services",
"state": "MI",
"license": "4301065909",
"primary": true
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "MI",
"license": "4301065909",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "104184200",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "104205660",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS OF MI",
"identifier": "RE065909",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.