NPIMap

Organization Active NPI

Community Orthopedic Surgery PC

  • Orthopaedic Hand Surgery Physician
  • Ypsilanti, MI
National Provider Identifier
1104867910
Registry record updated Jun 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Hand Surgery PhysicianTaxonomy code 207XS0106X
License
RN043612 Issued in MI
Legal business name
COMMUNITY ORTHOPEDIC SURGERY PC
Practice address
5315 Elliott Dr
Suite 202
Ypsilanti, MI 48197-8634
Phone
(734) 712-0600
Fax
(734) 712-0522
NPI assigned
Jun 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2008

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

Authorized official

Name
Mrs. Sandra D Bolton
Title
Billing Manager
Phone
(734) 712-0635

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X
Orthopaedic Hand Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XS0106X RN043612 MI Primary

Addresses

Primary practice location

5315 Elliott Dr
Suite 202
Ypsilanti, MI 48197-8634

Mailing address

5315 Elliott Dr
Suite 202
Ypsilanti, MI 48197-8634
Phone (734) 712-0600

Other identifiers 2

IdentifierTypeStateIssuer
540D711950OtherMIBCBSM DME
540H115470OtherMIBCBSM DME

National Provider Directory

National Provider Directory

Locations

420 W Russell St
Ste 109
Saline, MI 48176
Phone (734) 429-0208

Practitioners & affiliated clinicians

Practitioners 5

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": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213920000000",
    "number": "1104867910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5315 ELLIOTT DR",
            "address_2": "SUITE 202",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481978634",
            "telephone_number": "734-712-0600",
            "fax_number": "734-712-0522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5315 ELLIOTT DR",
            "address_2": "SUITE 202",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481978634",
            "telephone_number": "734-712-0600",
            "fax_number": "734-712-0522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY ORTHOPEDIC SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2008-06-20",
        "status": "A",
        "authorized_official_last_name": "BOLTON",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "734-712-0635",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "MI",
            "license": "RN043612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM DME",
            "identifier": "540D711950",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM DME",
            "identifier": "540H115470",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ypsilanti, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2008; 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.