NPIMap

Organization Active NPI

St Joseph Mercy Hospital

  • Psychiatry Physician
  • Canton, MI
National Provider Identifier
1043424690
Registry record updated Oct 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
ST JOSEPH MERCY HOSPITAL
Practice address
2200 N Canton Center Rd
Suite 200B
Canton, MI 48187-5065
Phone
(734) 981-3800
NPI assigned
May 10, 2007
Last updated
Oct 5, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2017

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

Authorized official

Name
Michael P Gusho
Title
Cfo SE Mi Region
Phone
(248) 858-6174

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X
Clinical Psychologist 103TC0700X
Clinical Social Worker 1041C0700X
Marriage & Family Therapist 106H00000X
Psychiatry Physician 2084P0800X Primary
Prescribing (Medical) Psychologist 103TP0016X

Addresses

Primary practice location

2200 N Canton Center Rd
Suite 200B
Canton, MI 48187-5065

Mailing address

34505 W 12 Mile Rd Ste 200
Farmington Hills, MI 48331-3286
Phone (734) 343-3922

Other identifiers 1

IdentifierTypeStateIssuer
10434OtherMIBLUE CROSS

National Provider Directory

National Provider Directory
Tax ID family
St Joseph Mercy Hospital25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

Practitioners & affiliated clinicians

Practitioners 1

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": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507161600000",
    "number": "1043424690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34505 W 12 MILE RD STE 200",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483313286",
            "telephone_number": "734-343-3922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 N CANTON CENTER RD",
            "address_2": "SUITE 200B",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481875065",
            "telephone_number": "734-981-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOSEPH MERCY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2017-10-05",
        "status": "A",
        "authorized_official_last_name": "GUSHO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CFO SE MI REGION",
        "authorized_official_telephone_number": "248-858-6174"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "10434",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2017; 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.