BEACON KALAMAZOO INC — NPI 1629495320 (Board-Certified Emergency Medicine Physician (ER / Trauma Doctor) in THREE RIVERS, MI)

CMS-1500 Box 24J / 33a • NPI

1629495320

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

207P00000X (CMS 93)

Board-Certified Emergency Medicine Physician (ER / Trauma Doctor)

Box 32 Service Location & ZIP+4

701 S HEALTH PKWY, THREE RIVERS, MI, 49093-8352

✓ 9-Digit EDI 837 ZIP+4 (49093-8352)

Practice Phone & Referral Fax

(269) 273-8557

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1629495320 (BEACON KALAMAZOO INC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1629495320` (NPI-2 Organization / Facility)
Provider / Legal Name	BEACON KALAMAZOO INC
Plain-English Specialty	Board-Certified Emergency Medicine Physician (ER / Trauma Doctor) NUCC Code: `207P00000X` (Emergency Medicine)
Certifying / Licensing Body	American Board of Emergency Medicine (ABEM)
Practice Location Address	701 S HEALTH PKWY, THREE RIVERS, MI, 49093-8352
Practice Telephone / Fax	Tel: (269) 273-8557
Administrative Mailing Address	3245 HEALTH DR STE 100, GRANGER, IN, 46530-1380
Enumeration & Last Sync	Enumerated: 2014-03-20 \| CMS Record Updated: 2026-10-09
Authorized Official	IRENE MAFFETONE (Manager Contracting and Payor Relat)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

701 S HEALTH PKWY, THREE RIVERS, MI, 49093-8352

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Plain-English Taxonomy & CMS Crosswalk (207P00000X)

What Does Taxonomy Code 207P00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207P00000X translates to:
"Board-Certified Emergency Medicine Physician (ER / Trauma Doctor)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 93 (Physician/Emergency Medicine)
Certifying / Accrediting Authority: American Board of Emergency Medicine (ABEM)
Clinical Scope: Immediate life-or-limb emergencies, severe chest pain, stroke symptoms, deep contaminated wounds needing tetanus prophylaxis, or severe dehydration.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (BEACON KALAMAZOO INC)

Typical CPT / Diagnostic Procedures:

Level 4 & Level 5 Emergency Department Resuscitation (CPT 99284–99285)
Point-of-Care Emergency Ultrasound (eFAST), Intubation & Central Line Placement
Acute Laceration Repair, Tetanus Prophylaxis & Fracture Splinting

Common Therapeutic Classes:

Epinephrine Auto-Injectors / IV Infusions, Atropine & Amiodarone
Tetanus Toxoid / Tdap & Tetanus Immunoglobulin (TIG)
Empiric Sepsis Antibiotics, Parenteral Ketorolac & Ondansetron

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`207P00000X` — Emergency Medicine Plain English: Board-Certified Emergency Medicine Physician (ER / Trauma Doctor)	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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BEACON KALAMAZOO INC (NPI #1629495320)