Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

DR. DAERYL DAVE ELGINCOLIN AMPONIN MD
NPI 1093419301
Emergency Medicine in Lanse, MI

Q: What is Daeryl Dave Amponin's NPI number?

The NPI number for Daeryl Dave Amponin is 1093419301. It was assigned to this individual provider in the NPPES registry on March 29, 2023.

Q: What is Daeryl Dave Amponin's specialty?

The primary specialty registered for this NPI is Emergency Medicine with taxonomy code 207P00000X.

Active since March 29, 2023PECOS Enrolled

18341 US HIGHWAY 41, LANSE, MI 49946(906) 524-3300 Get Directions Write a Review

NPPES record last updated: September 29, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Sep 29, 2026, Mar 29, 2023 (2 updates tracked since 2023).

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About Dr. Daeryl Dave Elgincolin Amponin Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. DAERYL DAVE ELGINCOLIN AMPONIN MD (NPI 1093419301) is an individual emergency medicine provider in Lanse, Michigan, licensed in Michigan (4351050910) and active in the NPI registry since March 2023. He is enrolled in Medicare PECOS, is affiliated with Baraga County Memorial Hospital, and maintains a secondary practice location in Southfield.

NPPES Registry Identity

NPI1093419301

Entity TypeIndividualMale

Primary Taxonomy207P00000X

Provider Legal NameDR. DAERYL DAVE ELGINCOLIN AMPONINCredential: MD

Location Address18341 US HIGHWAY 41Lanse, MI 49946-8024

Mailing Address18341 Us Highway 41Lanse, MI 49946-8024 · (906) 524-3300

Phone(906) 524-3300

Sole ProprietorNo

Medical School CMSOtherGraduated 2023

Enumeration DateMarch 29, 2023

Last NPPES UpdateSeptember 29, 20262 updates tracked since enumeration

NPPES CertifiedSeptember 29, 2026

✔ NPI 1093419301 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207P00000X

Licenses✔ Licensed in MI · 4351050910✔ Licensed in MN · 83667

Definition

An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

18341 US HIGHWAY 41, Lanse, MI 49946

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Secondary Practice Location 1

Location 116001 W 9 Mile RdSouthfield, MI 48075-4818 · Phone (248) 849-5664

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Daeryl Dave Elgincolin Amponin Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7214397512

PECOS Enrollment IDI20260812000532

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Daeryl Dave Amponin reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Baraga County Memorial Hospital

Same address

Emergency Medicine

18341 US HIGHWAY 41
Lanse, MI 49946

Reassigned Medicare billing, Michigan enrollment
Also billed through NPI 1558479824 (Michigan)
73 clinicians in this Medicare group

NPI 1508960600 (906) 524-3300

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Baraga County Memorial Hospital

Critical Access Hospitals · L' Anse, MI

OwnershipGovernment - Local

CMS Certification Number231307

Location18341 Us Highway 41L' Anse, MI 49946 · Baraga County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 49946 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$84.74 typical visit price

range $54.34 – $166.68

Typical copayment $21.18 (range $13.58 – $41.67)

Most-billed visit code 99203

Established Patient

$96.44 typical visit price

range $17.09 – $135.40

Typical copayment $24.11 (range $4.27 – $33.85)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PEYTON ELIZABETH HOLMA PA

Physician Assistant