Domenico S Ausiello MD PC
Organization Active NPI Family Medicine Physician · Greenville, MI
NPI 1972806594 · NPPES record last updated Dec 21, 2010
Key facts
- NPI
- 1972806594
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 4301053623 (MI)
- Legal business name
- DOMENICO S AUSIELLO MD PC
- Practice address
- 200 S Franklin St
Greenville, MI 48838-1740 - Phone
- (616) 754-6949
- Fax
- (616) 754-1062
- NPI assigned
- Dec 21, 2010
- Organization subpart
- No
Authorized official
- Name
- Diane Andres
- Title
- Credentialing/Billing
- Phone
- (616) 754-6949
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D0980172 | Domenico S Ausiello, MD, PC | Certificate of waiver | Nov 13, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110406000439 | MI | Part B Supplier - Clinic/Group Practice | 3577747104 |
Receives reassigned benefits from 1 practitioner Practice locations: Greenville, MI |
National Provider Directory
Locations
200 S Franklin St
Greenville, MI 48838
Phone (616) 754-6949
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 4301053623 | MI | Yes |
Addresses
Primary practice location
200 S Franklin St
Greenville, MI 48838-1740
Mailing address
200 S Franklin St
Greenville, MI 48838-1740
Phone (616) 754-6949
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0590023 | Other | MI | BLUE CROSS BLUE SHIELD OF MICHIGAN |
| 2751016 | Medicaid | MI |
Other providers in Greenville, MI
- Matthew Peter Dekraker
- Samantha Lynn Denslow
- Matthew B Dewys
- Joy Dickinson
- Mitchell Doerr
- Julie Ann Dragt
- Delaney Sue Drumm
- DTG II PLLC
- Brayden Gerald Durfee
- Alisa Duvall
All providers in Greenville, MI · Family Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 21, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.