Individual provider Active NPI

Ilsa Weyer Ittner, D.O.

  • Family Medicine Physician
  • Burton, MI
National Provider Identifier
1982997326
Registry record updated Nov 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101019262 Issued in MI
Practice address
1460 N Center Rd
Burton, MI 48509-1429
Phone
(810) 695-9996
NPI assigned
May 18, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 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 5101019262 MI Primary

Addresses

Primary practice location

1460 N Center Rd
Burton, MI 48509-1429

Mailing address

1460 N Center Rd
Burton, MI 48509-1429
Phone (810) 695-9996

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
I20140410001953 MI Practitioner - Family Practice 7113159872 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Human Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Edward W Sparrow Hospital AssociationGroup PAC ID 6709799166, 698 clinicians

Practice addresses (Care Compare)

7335 Westshire Dr
100 SMG West
Lansing, MI 48917-9703
Phone (517) 622-2788

Hospital & facility affiliations

  • Edward W Sparrow Hospital Hospital, Lansing, MI, CCN 230230
  • McLaren Greater Lansing Hospital, Lansing, MI, CCN 230167

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health Genesys Hospital Family Medicine CurrentSince Sep 1, 2014 Accepting new patients
Edward W Sparrow Hospital Association Family Medicine CurrentSince Nov 1, 2019 Accepting new patients
Ascension Genesys Hospital CurrentSince Sep 1, 2014 Accepting new patients
Edward W. Sparrow Hospital Association Current Accepting new patients
Henry Ford Health Genesys Hospital Current Accepting new patients
Edward W. Sparrow Hospital Association Family Medicine CurrentSince Nov 1, 2019 Accepting new patients
Edward W. Sparrow Hospital Association Past Accepting new patients

Locations

8175 Reliable Pkwy
Chicago, IL 60686

1460 N Center Rd
Burton, MI 48509
Phone (810) 424-2011

420 S Saginaw St
Flint, MI 48502
Phone (810) 232-3522

5445 Ali Dr
Dept 300
Grand Blanc, MI 48439

7335 Westshire Dr
Ste 100
Lansing, MI 48917
Phone (517) 622-2788

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8209/brand/5/csg/21/fhir/r4
  • Direct secure messaging: iittner75324@sparrowdirecthie.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 3

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": "1305676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415059200000",
    "number": "1982997326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1460 N CENTER RD",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485091429",
            "telephone_number": "810-695-9996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 N CENTER RD",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485091429",
            "telephone_number": "810-695-9996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ITTNER",
        "first_name": "ILSA",
        "middle_name": "WEYER",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-18",
        "last_updated": "2014-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101019262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burton, MI

Sources for this page

Verify at the official NPI Registry.