NPIMap

Organization Active NPI

McLaren Oakland

  • Family Medicine Physician
  • Pontiac, MI
National Provider Identifier
1053463778
Registry record updated May 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
630120 Issued in MI
Legal business name
MCLAREN OAKLAND
Practice address
50 N Perry St
Pontiac, MI 48342-2217
Phone
(248) 338-5000
Fax
(248) 338-5564
NPI assigned
Jan 16, 2007
Last updated
May 1, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2020

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

Authorized official

Name
Lynn Marcotte
Title
VP/Cfo
Phone
(248) 338-5691

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 630120 MI
Emergency Medicine Physician 207P00000X 630120 MI
Family Medicine Physician 207Q00000X 630120 MI Primary
Internal Medicine Physician 207R00000X 630120 MI
Cardiovascular Disease Physician 207RC0000X 630120 MI
Hematology & Oncology Physician 207RH0003X
Pediatrics Physician 208000000X 630120 MI
Diagnostic Radiology Physician 2085R0202X 630120 MI
General Practice Physician 208D00000X 630120 MI
Podiatrist 213E00000X 630120 MI

Addresses

Primary practice location

50 N Perry St
Pontiac, MI 48342-2217

Mailing address

50 N Perry St
Pontiac, MI 48342-2217
Phone (248) 338-5000

Other identifiers 2

IdentifierTypeStateIssuer
700F376860OtherMIBCBSM PROF GRP MD DO
700F373630OtherMIBCBSM PROG GRP PODIATRY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031111000770 MI Part B Supplier - Clinic/Group Practice 0547173213 Receives reassigned benefits from 77 practitioners
1 other NPI on this enrollment
Practice locations: Waterford, MI; Pontiac, MI; Oxford, MI; Mount Clemens, MI; Ortonville, MI; Clarkston, MI; Bloomfield Hills, MI; Lake Orion, MI…

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

180 N Ortonville Rd
Ortonville, MI 48462
Phone (248) 627-3535

385 N Lapeer Rd
Oxford, MI 48371
Phone (248) 628-2597

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lake Orion Nursing and Rehabilitation CenterLake Orion, MI, CCN 235481 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Direct Ownership Interest		 Dec 1, 1989
Dec 1, 1989

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 87

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.

View all 87

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588291200000",
    "number": "1053463778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 N PERRY ST",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483422217",
            "telephone_number": "248-338-5000",
            "fax_number": "248-338-5564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 N PERRY ST",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483422217",
            "telephone_number": "248-338-5000",
            "fax_number": "248-338-5564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLAREN OAKLAND",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2020-05-01",
        "certification_date": "2020-05-01",
        "status": "A",
        "authorized_official_last_name": "MARCOTTE",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "VP/CFO",
        "authorized_official_telephone_number": "248-338-5691"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "630120",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "630120",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "630120",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "630120",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": "630120",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "630120",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "630120",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "630120",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MI",
            "license": "630120",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM PROF GRP MD DO",
            "identifier": "700F376860",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM PROG GRP PODIATRY",
            "identifier": "700F373630",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pontiac, MI

Sources for this page

Verify at the official NPI Registry.