NPIMap

Organization Active NPI

St. Clair Medical P.C

  • Family Medicine Physician
  • Port Huron, MI
National Provider Identifier
1073563102
Registry record updated Oct 22, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ST. CLAIR MEDICAL P.C
Practice address
1209 10TH St
Suite E
Port Huron, MI 48060-5262
Phone
(810) 985-8170
Fax
(810) 985-4660
NPI assigned
May 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2007

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

Authorized official

Name
Ira Sabbagh, M.D.NPI 1619978780
Title
Owner
Phone
(810) 987-1590

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1209 10TH St
Suite E
Port Huron, MI 48060-5262

Mailing address

1209 10TH St
Suite E
Port Huron, MI 48060-5262
Phone (810) 985-8170

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031121000097 MI Part B Supplier - Clinic/Group Practice 1850295916 Receives reassigned benefits from 9 practitioners
Practice locations: Port Huron, MI; East China, MI; Brockway, MI

National Provider Directory

National Provider Directory

Locations

1209 10th St
Ste C
Port Huron, MI 48060
Phone (810) 985-7710

1209 10th St
Ste E
Port Huron, MI 48060
Phone (810) 985-8170

Practitioners & affiliated clinicians

Practitioners 12

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": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193011200000",
    "number": "1073563102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1209 10TH ST",
            "address_2": "SUITE E",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480605262",
            "telephone_number": "810-985-8170",
            "fax_number": "810-985-4660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1209 10TH ST",
            "address_2": "SUITE E",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480605262",
            "telephone_number": "810-985-8170",
            "fax_number": "810-985-4660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CLAIR MEDICAL P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2007-10-22",
        "status": "A",
        "authorized_official_last_name": "SABBAGH",
        "authorized_official_first_name": "IRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-987-1590",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Huron, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2007; 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.