NPIMap

Organization Active NPI

C R Alderdice D O

  • Family Medicine Physician
  • Saint Joseph, MI
National Provider Identifier
1972807147
Registry record updated Jan 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101008526 Issued in MI
Legal business name
C R ALDERDICE D O
Practice address
1906 Langley Ave
Saint Joseph, MI 49085-1739
Phone
(269) 982-1722
NPI assigned
Jan 3, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2011

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

Authorized official

Name
Charles Alderdice, D.O.NPI 1821056649
Title
Physician
Phone
(269) 982-1722

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 5101008526 MI Primary

Addresses

Primary practice location

1906 Langley Ave
Saint Joseph, MI 49085-1739

Mailing address

1906 Langley Ave
Saint Joseph, MI 49085-1739
Phone (269) 982-1722

Other identifiers 4

IdentifierTypeStateIssuer
1607063MedicaidMI
5083312OtherAETNA PIN
5110022OtherMEDICARE PTAN
5110022OtherMIBLUE CROSS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1294012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294012800000",
    "number": "1972807147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1906 LANGLEY AVE",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490851739",
            "telephone_number": "269-982-1722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1906 LANGLEY AVE",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490851739",
            "telephone_number": "269-982-1722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C R ALDERDICE D O",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-03",
        "last_updated": "2011-01-03",
        "status": "A",
        "authorized_official_last_name": "ALDERDICE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "269-982-1722",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101008526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1607063",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "5083312",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "5110022",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "5110022",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2011; 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.