NPIMap

Organization Active NPI

Michigan Institute of Urology PC

  • Durable Medical Equipment & Medical Supplies
  • Commerce Township, MI
National Provider Identifier
1053401752
Registry record updated May 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
MICHIGAN INSTITUTE OF UROLOGY PC
Practice address
1 William Carls Dr
Commerce Township, MI 48382-2201
Phone
(248) 624-9900
Fax
(248) 896-5450
NPI assigned
Oct 13, 2006
Organization subpart
Yes
Parent organization
MICHIGAN INSTITUTE OF UROLOGY PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 15, 2008

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

Authorized official

Name
Alphonse M Santino, M.D.
Title
President
Phone
(586) 771-4820

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208800000X
Pediatric Urology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2088P0231X
Durable Medical Equipment & Medical Supplies 332B00000X Primary
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

1 William Carls Dr
Commerce Township, MI 48382-2201

Mailing address

20952 E 12 Mile Rd
Suite 200
Saint Clair Shores, MI 48081-3200
Phone (586) 771-4820

Other identifiers 3

IdentifierTypeStateIssuer
540E016120OtherMIBCBSM DME
CB9133OtherMIRAILROAD MEDICARE
340E062730OtherMIBCBSM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031125000770 MI Part B Supplier - Clinic/Group Practice 1052223492 Receives reassigned benefits from 96 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Novi, MI; Pontiac, MI; Rochester, MI; Rochester Hills, MI; Saint Clair Shores, MI; Southfield, MI; Troy, MI; Utica, MI…
O20050329001170 MI Part B Supplier - Clinic/Group Practice 1052223492 Receives reassigned benefits from 21 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: West Bloomfield, MI; Utica, MI; Troy, MI; Saint Clair Shores, MI; Rochester Hills, MI; Pontiac, MI; Macomb, MI; Livonia, MI…

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Wayne Macomb Urolog

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210809600000",
    "number": "1053401752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20952 E 12 MILE RD",
            "address_2": "SUITE 200",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480813200",
            "telephone_number": "586-771-4820",
            "fax_number": "586-771-6620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WILLIAM CARLS DR",
            "city": "COMMERCE TOWNSHIP",
            "state": "MI",
            "postal_code": "483822201",
            "telephone_number": "248-624-9900",
            "fax_number": "248-896-5450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN INSTITUTE OF UROLOGY PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MICHIGAN INSTITUTE OF UROLOGY PC",
        "enumeration_date": "2006-10-13",
        "last_updated": "2008-05-15",
        "status": "A",
        "authorized_official_last_name": "SANTINO",
        "authorized_official_first_name": "ALPHONSE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-771-4820",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Urology, Pediatric Urology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM DME",
            "identifier": "540E016120",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CB9133",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "340E062730",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Commerce Township, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.