NPIMap

Organization Active NPI

St. Clair Orthopaedics and Sports Medicine PC

  • Physical Therapist
  • Saint Clair Shores, MI
National Provider Identifier
1073385738
Registry record updated Oct 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ST. CLAIR ORTHOPAEDICS AND SPORTS MEDICINE PC
Practice address
23829 Little Mack Ave Ste 100
Saint Clair Shores, MI 48080-1186
Phone
(586) 773-1300
NPI assigned
Oct 26, 2023
Last updated
Oct 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2023

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

Authorized official

Name
Elaine Russette
Title
Credentialing
Phone
(586) 552-4573

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary
Hand Occupational Therapist 225XH1200X NU

Addresses

Primary practice location

23829 Little Mack Ave Ste 100
Saint Clair Shores, MI 48080-1186

Mailing address

23829 Little Mack Ave Ste 100
Saint Clair Shores, MI 48080-1186
Phone (586) 773-1300

Other practice location 1

22701 Hall Rd Ste 100
Macomb, MI 48042-5270
Phone (586) 416-1300

National Provider Directory

National Provider Directory
Tax ID family
St Clair Ortho SPT Med PC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.1621

NPI Registry JSON

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

{
    "created_epoch": "1698278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698278400000",
    "number": "1073385738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23829 LITTLE MACK AVE STE 100",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801186",
            "telephone_number": "586-773-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23829 LITTLE MACK AVE STE 100",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801186",
            "telephone_number": "586-773-1300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22701 Hall Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Macomb",
            "state": "MI",
            "postal_code": "480425270",
            "country_code": "US",
            "telephone_number": "586-416-1300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST. CLAIR ORTHOPAEDICS AND SPORTS MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-26",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A",
        "authorized_official_last_name": "RUSSETTE",
        "authorized_official_first_name": "ELAINE",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "586-552-4573"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225XH1200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Hand",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2023; 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.