Organization Active NPI

Kalkaska Family Practice PC

  • Family Medicine Physician
  • Kalkaska, MI
National Provider Identifier
1962438556
Registry record updated Jan 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
KALKASKA FAMILY PRACTICE PC
Practice address
419 S Coral St
Kalkaska, MI 49646-2500
Phone
(231) 258-7777
NPI assigned
Jun 24, 2006
Last updated
Jan 5, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2012

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

Authorized official

Name
Doreen M Birgy
Title
Practice MGR
Phone
(231) 258-7570

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

419 S Coral St
Kalkaska, MI 49646-2500

Mailing address

419 S Coral St
Kalkaska, MI 49646-2500
Phone (231) 258-7777

Other identifiers 2

IdentifierTypeStateIssuer
1962438556MedicaidMI
080Z56005OtherMIBCBS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325721600000",
    "number": "1962438556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 S CORAL ST",
            "city": "KALKASKA",
            "state": "MI",
            "postal_code": "496462500",
            "telephone_number": "231-258-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 S CORAL ST",
            "city": "KALKASKA",
            "state": "MI",
            "postal_code": "496462500",
            "telephone_number": "231-258-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALKASKA FAMILY PRACTICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2012-01-05",
        "status": "A",
        "authorized_official_last_name": "BIRGY",
        "authorized_official_first_name": "DOREEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRACTICE MGR",
        "authorized_official_telephone_number": "231-258-7570"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962438556",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "080Z56005",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalkaska, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2012; 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.