NPIMap

Individual provider Active NPI

Loren M Wise, MD

  • Family Medicine Physician
  • Kalamazoo, MI
National Provider Identifier
1972573442
Registry record updated Oct 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301078298 Issued in MI
Practice address
5629 Stadium Dr
Suite D
Kalamazoo, MI 49009-1952
Phone
(269) 372-5701
Fax
(269) 372-5702
NPI assigned
Jan 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301078298 MI Primary

Addresses

Primary practice location

5629 Stadium Dr
Suite D
Kalamazoo, MI 49009-1952

Mailing address

601 John St
Box 42
Kalamazoo, MI 49007-5341
Phone (269) 372-5701

Other identifiers 2

IdentifierTypeStateIssuer
CA4396OtherMIRAILROAD MEDICARE
4635894MedicaidMI

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
I20041008001435 MI Practitioner - Family Practice 3274592688 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Human Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Munson Healthcare Charlevoix HospitalGroup PAC ID 4284528035, 57 clinicians

Practice addresses (Care Compare)

223 N Park St
Charlevoix Area Hospital
Boyne City, MI 49712-1220
Phone (231) 582-5314

Hospital & facility affiliations

  • McLaren Home Health Home health agency, Cheboygan, MI, CCN 237160
  • Charlevoix Area Hospital Hospital, Charlevoix, MI, CCN 231322
  • Munson Healthcare Otsego Memorial Hospital Hospital, Gaylord, MI, CCN 230133
  • Munson Medical Center Hospital, Traverse City, MI, CCN 230097
  • McLaren Northern Michigan Hospital, Petoskey, MI, CCN 230105

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
McLaren Northern Michigan Family Medicine CurrentSince Nov 29, 2012 Accepting new patients
Munson Healthcare Charlevoix Hospital Family Medicine CurrentSince Apr 20, 2015 Accepting new patients
Munson Healthcare Charlevoix Hospital Family Medicine CurrentSince Apr 20, 2015 Accepting new patients
Munson Medical Center CurrentSince Apr 1, 2014 Accepting new patients
McLaren Northern Michigan CurrentSince Nov 29, 2012 Accepting new patients
Munson Medical Center Family Medicine CurrentSince Apr 1, 2014 Accepting new patients
Munson Medical Center Current Accepting new patients
Munson Healthcare Charlevoix Hospital Past Accepting new patients
Michigan State University Kalamazoo Center for Medical Studies Past Accepting new patients

Locations

2513 Momentum Pl
Chicago, IL 60689
Phone (231) 935-8031

223 N Park St
Boyne City, MI 49712
Phone (231) 582-5314

416 Connable Ave
Petoskey, MI 49770
Phone (231) 487-4000

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

1400 Medical Campus Dr
Traverse City, MI 49684
Phone (231) 935-8000

Interoperability endpoints

  • Direct secure messaging: lorenwise@cah.cernerdirect.com

Organizations & group practices 9

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 6

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": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412899200000",
    "number": "1972573442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 JOHN ST",
            "address_2": "BOX 42",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075341",
            "telephone_number": "269-372-5701",
            "fax_number": "269-372-5702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5629 STADIUM DR",
            "address_2": "SUITE D",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490091952",
            "telephone_number": "269-372-5701",
            "fax_number": "269-372-5702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "LOREN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-25",
        "last_updated": "2014-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301078298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CA4396",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4635894",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.