Active NPI
Anthony R Pucci, DO
- Diagnostic Radiology Physician
- Petoskey, MI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 5101010113
- Practice address
- 416 Connable Ave
Petoskey, MI 49770-2212 - Phone
- (231) 487-4000
- NPI assigned
- Jul 18, 2005
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 5101010113 | MI | Primary |
Addresses
Primary practice location
416 Connable Ave
Petoskey, MI 49770-2212
Mailing address
330 E Mitchell St
Suite 210
Petoskey, MI 49770-2671
Phone (866) 287-5269
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00227931 | Other | MI | RAILROAD MEDICARE |
| 3152410324 | Other | MI | BCBS |
| AP010113 | Other | MI | BCBS |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Diagnostic Radiology
- Education
- Other, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
5900 Byron Ctr Ave SW
Wyoming, MI 49519-9606
Phone (616) 252-7200
Hospital & facility affiliations
- University of Michigan Health - West
- Spectrum Health
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10113 | MI | MD | Pediatric Dentist |
| 5101010113 | MI | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Metropolitan Hospital | Current | Accepting new patients | |
| Metropolitan Hospital | Past | Accepting new patients | |
| Dr L Reynolds Assoc PC | Past | Accepting new patients | |
| Metropolitan Hospital | Past | Accepting new patients | |
| Advanced Radiology Services PC | Diagnostic Radiology | Past | Accepting new patients |
Locations
5950 Metro Way SW
Wyoming, MI 49519
Phone (616) 252-8100
5900 Byron Center Ave SW
Wyoming, MI 49519
Phone (616) 252-3243
Organizations & group practices 5
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.
-
- Internal Medicine Physician
- Wyoming, MI
- NPI 1811937519
-
- Diagnostic Radiology Physician
- Grand Rapids, MI
- NPI 1740283324
-
- Specialist
- Southfield, MI
- NPI 1669423265
-
- Family Medicine Physician
- Wyoming, MI
- NPI 1114947538
-
- Anatomic Pathology & Clinical Pathology Physician
- Wyoming, MI
- NPI 1336182542
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Wyoming, MI
- NPI 1619923919
-
- Critical Access Hospital
- Hastings, MI
- NPI 1932695525
-
- General Acute Care Hospital
- Grand Rapids, MI
- NPI 1922090554
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1922007582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "330 E MITCHELL ST",
"address_2": "SUITE 210",
"city": "PETOSKEY",
"state": "MI",
"postal_code": "497702671",
"telephone_number": "866-287-5269"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "416 CONNABLE AVE",
"city": "PETOSKEY",
"state": "MI",
"postal_code": "497702212",
"telephone_number": "231-487-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCCI",
"first_name": "ANTHONY",
"middle_name": "R",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "MI",
"license": "5101010113",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00227931",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "3152410324",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "AP010113",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Petoskey, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.