NPIMap

Individual provider Active NPI

Derek J Babin, MPT

  • Physical Therapist
  • Kalamazoo, MI
National Provider Identifier
1972546372
Registry record updated Sep 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501009775 Issued in MI
Practice address
4613 W Main St
Suite C
Kalamazoo, MI 49006-2645
Phone
(269) 488-8360
Fax
(269) 488-8359
NPI assigned
Jun 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501009775 MI Primary

Addresses

Primary practice location

4613 W Main St
Suite C
Kalamazoo, MI 49006-2645

Mailing address

4613 W Main St
Suite C
Kalamazoo, MI 49006-2645
Phone (269) 488-8360

Other identifiers 2

IdentifierTypeStateIssuer
155812OtherGREAT LAKES HLTH PLN
7173604OtherAETNA GRP PIN

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
5501009775MIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Healthcare Midwest PC Past Accepting new patients
Healthcare Midwest PC Past Accepting new patients
Healthcare Midwest PC Past Accepting new patients
Healthcare Midwest PC Past Accepting new patients
Healthcare Midwest PC Past Accepting new patients
Healthcare Midwest PC Past Accepting new patients
Healthcare Midwest PC Past Accepting new patients

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252454400000",
    "number": "1972546372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4613 W MAIN ST",
            "address_2": "SUITE C",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490062645",
            "telephone_number": "269-488-8360",
            "fax_number": "269-488-8359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4613 W MAIN ST",
            "address_2": "SUITE C",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490062645",
            "telephone_number": "269-488-8360",
            "fax_number": "269-488-8359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BABIN",
        "first_name": "DEREK",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2009-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501009775",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT LAKES HLTH PLN",
            "identifier": "155812",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA GRP PIN",
            "identifier": "7173604",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 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.

Verify at the official NPI Registry.