Michigan Spine and Pain – Specialist, NPI 1487796504
Specialist
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Michigan Spine and Pain
2480 W CAMPUS DR
SUITE 500
MT PLEASANT, MI 488585414
Phone: (989) 772-1609
Fax: (989) 953-4949
Type: Mailing
6079 W. MAPLE ROAD
SUITE 100B
WEST BLOOMFIELD, MI 48322
Phone: (989) 772-1609
Type: Location
2935 HEALTH PARKWAY
MT PLEASANT, MI 48858
Phone: (989) 772-1609
Fax: (989) 773-6279
Type: Mailing
6079 W. MAPLE RD.
STE. 100B
WEST BLOOMFIELD, MI 48322
Phone: (989) 772-1609
Fax: (989) 773-6279
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2025-12-31 (162 days ago).
Enrollment records
1
Earliest due date
2025-12-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040817000659 | O | Clinic/Group Practice | MI | 2025-12-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 48858)
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