Individual provider Active NPI

Kevin Richard Eckles, DPT

  • Physical Therapist
  • Lapeer, MI
National Provider Identifier
1992963375
Registry record updated Jun 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501013826 Issued in MI
Practice address
1191 S Lapeer Rd
Lapeer, MI 48446-3081
Phone
(810) 969-4841
Fax
(810) 969-4843
NPI assigned
Jun 2, 2008
Last updated
Jun 14, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501013826 MI Primary

Addresses

Primary practice location

1191 S Lapeer Rd
Lapeer, MI 48446-3081

Mailing address

1191 S Lapeer Rd
Lapeer, MI 48446-3081
Phone (810) 969-4841

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140522001784 MI Practitioner - Physical Therapist in Private Practice 8123241965 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ignite Physical Therapy LLCGroup PAC ID 4486909306, 2 clinicians

Practice addresses (Care Compare)

1191 S Lapeer Rd
Lapeer, MI 48446-3081
Phone (810) 969-4841

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1212364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686700800000",
    "number": "1992963375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1191 S LAPEER RD",
            "city": "LAPEER",
            "state": "MI",
            "postal_code": "484463081",
            "telephone_number": "810-969-4841",
            "fax_number": "810-969-4843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1191 S LAPEER RD",
            "city": "LAPEER",
            "state": "MI",
            "postal_code": "484463081",
            "telephone_number": "810-969-4841",
            "fax_number": "810-969-4843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ECKLES",
        "first_name": "KEVIN",
        "middle_name": "RICHARD",
        "name_prefix": "Mr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-02",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501013826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lapeer, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.