NPIMap

Organization Active NPI

Shenandoah Clinic, P.C.

  • Family Medicine Physician
  • Clawson, MI
National Provider Identifier
1043394877
Registry record updated Feb 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SHENANDOAH CLINIC, P.C.
Practice address
909 W Maple Rd
Suite 100
Clawson, MI 48017-1000
Phone
(248) 435-2028
Fax
(248) 435-2099
NPI assigned
Oct 25, 2006
Last updated
Feb 24, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2022

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

Authorized official

Name
Dr. Ronald I Rothenberg, DONPI 1487634986
Title
Physician/President
Phone
(248) 435-2028

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

909 W Maple Rd
Suite 100
Clawson, MI 48017-1000

Mailing address

909 W Maple Rd
Suite 100
Clawson, MI 48017-1000
Phone (248) 435-2028

Other identifiers 1

IdentifierTypeStateIssuer
080F319020OtherMIBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645660800000",
    "number": "1043394877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 W MAPLE RD",
            "address_2": "SUITE 100",
            "city": "CLAWSON",
            "state": "MI",
            "postal_code": "480171000",
            "telephone_number": "248-435-2028",
            "fax_number": "248-435-2099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 W MAPLE RD",
            "address_2": "SUITE 100",
            "city": "CLAWSON",
            "state": "MI",
            "postal_code": "480171000",
            "telephone_number": "248-435-2028",
            "fax_number": "248-435-2099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHENANDOAH CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A",
        "authorized_official_last_name": "ROTHENBERG",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "PHYSICIAN/PRESIDENT",
        "authorized_official_telephone_number": "248-435-2028",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "080F319020",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clawson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.