ASCENSION MEDICAL GROUP PROMED (NPI# 1720009954) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720009954 |
| Entity Type | Organization |
| Organization Name | ASCENSION MEDICAL GROUP PROMED |
| Practice Address |
1717 Shaffer St Ste 124 Kalamazoo MI 49048-1647 |
| Mailing Address |
1717 Shaffer St Ste 2 Kalamazoo MI 49048-1623 |
| Practice Telephone | 2693445552 |
| Mailing Telephone | 2695522836 |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2018-02-22 |
| Authorized Official Name | DAMON D. SORENSEN (CFO) |
| Authorized Official Telephone | 2692265607 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207QH0002X |
Family Medicine Specialization: Hospice and Palliative Medicine |
MI | Allopathic & Osteopathic Physicians | |
| N | 207RH0002X |
Internal Medicine Specialization: Hospice and Palliative Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RR0500X |
Internal Medicine Specialization: Rheumatology |
Allopathic & Osteopathic Physicians | ||
| N | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 208100000X | Physical Medicine & Rehabilitation | Allopathic & Osteopathic Physicians | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BCBSM | 700C910600 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538299631 | Ascension Medical Group Promed | Internal Medicine | 7895 Currier Dr, Portage, MI 49002-4314 | 2007-03-07 |
| 1063542165 | Ascension Medical Group Promed | Counselor | 7895 Currier Dr, Portage, MI 49002-4314 | 2007-03-07 |
| 1437201811 | Ascension Medical Group Promed | Obstetrics & Gynecology | 3025 Gull Rd, Ste 250, Kalamazoo, MI 49048-1281 | 2007-01-17 |
| 1013926997 | Ascension Medical Group Promed | Obstetrics & Gynecology | 8001 Angling Rd, Portage, MI 49024-7422 | 2006-08-07 |
| 1497709869 | Ascension Medical Group Promed | Internal Medicine | 7901 Angling Rd, Portage, MI 49024-0714 | 2006-05-20 |
| Street Address |
1717 SHAFFER ST STE 124 |
| City | KALAMAZOO |
| State | MI |
| Zip Code | 49048-1647 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457353658 | John A Carr | Surgery | 1717 Shaffer St, Kalamazoo, MI 49048-1647 | 2005-06-01 |
| 1114425279 | Restorix Health Inc | Nurse Practitioner | 1717 Shaffer St, Kalamazoo, MI 49048-1647 | 2018-01-24 |
| 1073982104 | Alexandra Rae Cook | Dietitian, Registered | 1717 Shaffer St, Suite 108, Kalamazoo, MI 49048-1647 | 2015-09-18 |
| 1881026300 | Amy Lynn Fedewa | Dietitian, Registered | 1717 Shaffer St, Kalamazoo, MI 49048-1647 | 2013-08-07 |
| 1104166909 | Alexandra M Timpson | Dietitian, Registered | 1717 Shaffer St, Ste 124, Kalamazoo, MI 49048-1647 | 2013-02-15 |
| 1992042295 | Emelia C Hirschman | Dietitian, Registered | 1717 Shaffer St, Kalamazoo, MI 49048-1647 | 2013-01-08 |
| 1144575283 | Adnan Kassier | Internal Medicine | 1717 Shaffer St, Kalamazoo, MI 49048-1647 | 2012-07-16 |
| 1679831358 | Bethany Herder | Dietitian, Registered | 1717 Shaffer St, Kalamazoo, MI 49048-1647 | 2012-05-01 |
| 1629355813 | Kelly Noel Becker | Registered Nurse | 1717 Shaffer St, Ste. 124, Kalamazoo, MI 49048-1647 | 2011-11-16 |
| 1730465584 | Linda E Kline | Nurse Practitioner | 1717 Shaffer St, Kalamazoo, MI 49048-1647 | 2011-10-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790214146 | Sally Leigh Weigandt | Technician, Other | 5438 Lucerne Ave, Kalamazoo, MI 49048 | 2017-06-08 |
| 1437606670 | Amanda Ezekiel | Advanced Practice Midwife | 1523 Gull Rd Ste 250, Kalamazoo, MI 49048 | 2016-09-06 |
| 1700238987 | Brittany Bittenbender | Technician, Other | 5840 E Cork St, Kalamazoo, MI 49048 | 2016-07-12 |
| 1255747176 | Araena Payton | Early Intervention Provider Agency | 1313 Hotop Ave, Kalamazoo, MI 49048 | 2014-07-11 |
| 1508297151 | Hope Network Eastwood House | Residential Treatment Facility, Physical Disabilities | 2236 Brook Drive, Kalamazoo, MI 49048 | 2013-12-09 |
| 1457780314 | Hope Network Rehabilitation Servicesq | Residential Treatment Facility, Physical Disabilities | 2236 Brooke Drive, Kalamazoo, MI 49048 | 2013-11-01 |
| 1467889576 | Aaron Van Heest | Social Worker | 813 Chrysler St., Kalamazoo, MI 49048 | 2013-10-03 |
| 1760737308 | Salem A. Salem | Internal Medicine | Ascension Borgess Hospital, 1521 Gull Rd, Kalamazoo, MI 49048 | 2012-07-19 |
| 1356523229 | Borgess Medical Center | Psychiatry & Neurology | 1521 Gull Road, Kalamazoo, MI 49048 | 2007-12-03 |
| 1629290135 | Robert Claude Gano | Dentist | 5462 Gull Rd Suite 7, Kalamazoo, MI 49048 | 2007-05-03 |
| Find all providers in zip 49048 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316582372 | Home Visiting Doctors Association P.C. | Internal Medicine | 251 N Rose St Ste 218, Kalamazoo, MI 49007-3860 | 2019-11-14 |
| 1669022307 | Ivana Nyirenda | Internal Medicine | 109 Candlewyck Dr Apt 621, Kalamazoo, MI 49001-5435 | 2019-09-15 |
| 1477946184 | Christopher Brackshaw | Internal Medicine | 601 John St., Box Number 74, Kalamazoo, MI 49007 | 2015-03-05 |
| 1043639933 | Andrew Heisler | Internal Medicine | 601 John St Ste M-030, Kalamazoo, MI 49007-5341 | 2014-04-08 |
| 1376983205 | Christopher Foster Hanzaker | Internal Medicine | 601 John St Ste M-170a, Kalamazoo, MI 49007 | 2013-06-25 |
| 1679919724 | Ryan Daryl Melvin | Internal Medicine | 601 John St Ste 100, Kalamazoo, MI 49007 | 2013-05-16 |
| 1760737308 | Salem A. Salem | Internal Medicine | Ascension Borgess Hospital, 1521 Gull Rd, Kalamazoo, MI 49048 | 2012-07-19 |
| 1154473635 | Venu Gourineni | Internal Medicine | 1722 Shaffer St Ste 1, Kalamazoo, MI 49048-1633 | 2007-01-17 |
| 1356436976 | Branko Grinfeld | Internal Medicine | 5943 Stadium Dr., Kalamazoo, MI 49009 | 2006-10-03 |
| 1962596502 | Rockelle Donishia Rogers | Internal Medicine | 117 W Paterson Street, Kalamazoo, MI 49007 | 2006-10-03 |
| Find all providers in KALAMAZOO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.