Individual provider Active NPI

Edward D Kreske, MD

  • Surgery Physician
  • Ypsilanti, MI
National Provider Identifier
1982644639
Registry record updated Sep 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
4301065380 Issued in MI
Practice address
5325 Elliott Dr
Suite 104
Ypsilanti, MI 48197-8633
Phone
(734) 712-8150
Fax
(734) 712-8151
NPI assigned
Jun 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 4301065380 MI Primary

Addresses

Primary practice location

5325 Elliott Dr
Suite 104
Ypsilanti, MI 48197-8633

Mailing address

5325 Elliott Dr
Suite 104
Ypsilanti, MI 48197-8633
Phone (734) 712-8150

Other identifiers 1

IdentifierTypeStateIssuer
4475235-10MedicaidMI

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
I20040331001320 MI Practitioner - General Surgery 4486646379 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Michigan Medical School, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iha Health Services CorporationGroup PAC ID 2466351440, 1,149 clinicians

Practice addresses (Care Compare)

128 Van Buren St
Chelsea, MI 48118-1623
Phone (734) 475-8677

2305 Genoa Bus Park Dr
Brighton, MI 48114-7005

44428 Woodward Ave
Suite 102
Pontiac, MI 48341-5009
Phone (734) 712-8700

51341 W Huron River Dr
Trinity Health Iha Medical Group Primary Ca
Van Buren Township, MI 48111-2571
Phone (734) 997-0304

5301 E Huron River Dr
Ypsilanti, MI 48197-1051

5301 McAuley Dr
Ypsilanti, MI 48197-1051

5303 Elliott Dr
Suite 202
Ypsilanti, MI 48197-8632
Phone (734) 712-2005

5315 Elliott Dr
Ypsilanti, MI 48197-8634

5325 Elliott Dr
Ypsilanti, MI 48197-8633

7575 Grand River Rd
Brighton, MI 48114-9309
Phone (734) 712-7255

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)11

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301065380MIMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Health Services Corporation Current Accepting new patients
Iha Health Services Corporation CurrentSince May 30, 2013 Accepting new patients
Iha Health Service Corporation CurrentSince May 30, 2013 Accepting new patients
Michigan Multispecialty Physicians, P.C. Surgery Past Accepting new patients
Iha Health Services Corporation Past Accepting new patients
Academic Surgery Program, P.C. PastSince Aug 1, 1977 Accepting new patients
Iha Health Services Corporation Past Accepting new patients

Locations

16507 Southfield Rd
Allen Park, MI 48101
Phone (313) 389-0648

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

7575 Grand River Rd
Ste 202
Brighton, MI 48114
Phone (810) 844-7566

2305 Genoa Business Park Dr
Ste 200
Brighton, MI 48114
Phone (810) 494-6840

49650 Cherry Hill Rd
Ste 120
Canton, MI 48187
Phone (734) 398-7800

14650 E Old US Highway 12
Ste 303
Chelsea, MI 48118
Phone (734) 475-4177

128 Van Buren St
Chelsea, MI 48118
Phone (734) 475-8677

44428 Woodward Ave
Ste 102
Pontiac, MI 48341
Phone (734) 712-8700

400 W Russell St
Ste 2100
Saline, MI 48176
Phone (734) 686-1018

5333 McAuley Dr
Rm 2115
Ypsilanti, MI 48197
Phone (734) 712-3971

5333 McAuley Dr
Rm 3001
Ypsilanti, MI 48197
Phone (734) 712-4120

5315 Elliott Dr
Ste 201
Ypsilanti, MI 48197
Phone (734) 712-2230

5325 Elliott Dr
Ste 104
Ypsilanti, MI 48197
Phone (734) 434-4200

Interoperability endpoints

  • Direct secure messaging: ekreske44570@direct.trinity-health.org

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.

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": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348012800000",
    "number": "1982644639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5325 ELLIOTT DR",
            "address_2": "SUITE 104",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481978633",
            "telephone_number": "734-712-8150",
            "fax_number": "734-712-8151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5325 ELLIOTT DR",
            "address_2": "SUITE 104",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481978633",
            "telephone_number": "734-712-8150",
            "fax_number": "734-712-8151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRESKE",
        "first_name": "EDWARD",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-08",
        "last_updated": "2012-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301065380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4475235-10",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ypsilanti, MI

Sources for this page

Verify at the official NPI Registry.