Individual provider Active NPI

Kenneth Eichenbaum, MD

  • Anesthesiology Physician
  • Troy, MI
National Provider Identifier
1962637892
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
4301108718 Issued in MI
Practice address
44201 Dequindre Rd
Troy, MI 48085-1117
Phone
(248) 964-5000
NPI assigned
May 21, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X A124518 CA
Anesthesiology Physician 207L00000X 4301108718 MI Primary

Addresses

Primary practice location

44201 Dequindre Rd
Troy, MI 48085-1117

Mailing address

PO Box 551420
Fort Lauderdale, FL 33355-1420
Phone (800) 243-3839

Other practice location 1

300 Pasteur Dr
Stanford, CA 94305-2200
Phone (650) 723-4000

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
I20170530000821 MI Practitioner - Anesthesiology 6002037884 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Icahn School of Medicine at Mount Sinai, 2009
Medicare assignment
May accept Medicare assignment
Group practices
Northstar Anesthesia of Michigan III PLLCGroup PAC ID 7911325469, 561 clinicians
Anesthesia Associates of Ann Arbor PLLCGroup PAC ID 1355317223, 213 clinicians

Practice addresses (Care Compare)

16815 E Jefferson Ave
Suite 1030
Grosse Pointe, MI 48230-1923
Phone (214) 687-0001

44405 Woodward Ave
Pontiac, MI 48341-5023
Phone (248) 585-3023

Hospital & facility affiliations

  • Trinity Health Oakland Hospital Hospital, Pontiac, MI, CCN 230029
  • Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130

Merit-based Incentive Payment System (MIPS)

Final score
67.5 of 100Reported as group
Quality
58.12
Improvement activities
40
Cost
68.45

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
124518CAMDSocial Worker
A124518CAMDAnesthesiology Physician
4301108718MIMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northstar Anesthesia of Michigan III PLLC CurrentSince Feb 1, 2021 Accepting new patients
Anesthesia Associates of Ann Arbor, PLLC Anesthesiology CurrentSince Jul 15, 2021 Accepting new patients

Locations

2006 Hogback Rd
Ste 5
Ann Arbor, MI 48105
Phone (313) 712-4331

16815 E Jefferson Ave
Ste 1030
Grosse Pointe, MI 48230

620 Byron Rd
Howell, MI 48843
Phone (517) 545-5450

44405 Woodward Ave
Pontiac, MI 48341
Phone (248) 858-3000

3601 W 13 Mile Rd
Royal Oak, MI 48073

44201 Dequindre Rd
Troy, MI 48085
Phone (248) 471-8255

33155 Annapolis St
Wayne, MI 48184
Phone (734) 467-4042

Interoperability endpoints

  • Direct secure messaging: keichenbaum1337057@direct.trinity-health.org

Organizations & group practices 2

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.

Hospital & facility affiliations 4

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": "1242864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1962637892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 551420",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333551420",
            "telephone_number": "800-243-3839",
            "fax_number": "844-414-8291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44201 DEQUINDRE RD",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480851117",
            "telephone_number": "248-964-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Pasteur Dr",
            "address_purpose": "LOCATION",
            "city": "Stanford",
            "state": "CA",
            "postal_code": "943052200",
            "country_code": "US",
            "telephone_number": "650-723-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EICHENBAUM",
        "first_name": "KENNETH",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-21",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A124518",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "4301108718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Troy, MI

Sources for this page

Verify at the official NPI Registry.