NPIMap

Individual provider Active NPI

Roger Matthew Kushner, D.O.

  • Obstetrics Physician
  • Livonia, MI
National Provider Identifier
1962467621
Registry record updated Mar 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics PhysicianTaxonomy code 207VX0000X
License
5101006358 Issued in MI
Practice address
20276 Middlebelt Rd
Suite 2
Livonia, MI 48152-2054
Phone
(248) 476-4900
Fax
(248) 476-5435
NPI assigned
Apr 18, 2006
Last updated
Mar 1, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics Physician 207VX0000X 5101006358 MI Primary

Addresses

Primary practice location

20276 Middlebelt Rd
Suite 2
Livonia, MI 48152-2054

Mailing address

20276 Middlebelt Road Suite 2
Livonia, MI 48152-2054
Phone (248) 476-4900

Other identifiers 6

IdentifierTypeStateIssuer
4033701OtherMIAETNA
47523OtherMIOMNI
E26610OtherMIHEALTH ALLIANCE PLAN
110978OtherMICARE CHOICES
160H261380OtherMIBCBS/BCN
4372550MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090109000495 MI Practitioner - Obstetrics/Gynecology 8820038334 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101006358MIMDObstetrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Mary Mercy Hospital Crna Current Accepting new patients
Beacon Medical Group Michigan Inc CurrentSince Jan 7, 2019 Accepting new patients
St Mary Mercy Hospital Professional CurrentSince May 1, 2008 Accepting new patients
Promed Healthcare CurrentSince Jan 7, 2019 Accepting new patients
Beacon Medical Group Michigan Inc Current Accepting new patients
St Mary Mercy Hospital Professional Current Accepting new patients
VHS Sinai-Grace Hospital Inc Past Accepting new patients
Roger Kushner DO P.C. Past Accepting new patients

Locations

1521 Gull Rd
Kalamazoo, MI 49048
Phone (269) 226-5165

36475 5 Mile Rd
Livonia, MI 48154
Phone (734) 464-4800

7901 Angling Rd
Portage, MI 49024
Phone (269) 324-8405

Interoperability endpoints

  • Direct secure messaging: rkushner2@direct.dmc.org

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519862400000",
    "number": "1962467621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20276 MIDDLEBELT ROAD SUITE 2",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481522054",
            "telephone_number": "248-476-4900",
            "fax_number": "248-476-5435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20276 MIDDLEBELT RD",
            "address_2": "SUITE 2",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481522054",
            "telephone_number": "248-476-4900",
            "fax_number": "248-476-5435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUSHNER",
        "first_name": "ROGER",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-18",
        "last_updated": "2018-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "MI",
            "license": "5101006358",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4033701",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OMNI",
            "identifier": "47523",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE PLAN",
            "identifier": "E26610",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE CHOICES",
            "identifier": "110978",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS/BCN",
            "identifier": "160H261380",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4372550",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Livonia, MI

Sources for this page

Verify at the official NPI Registry.