NPIMap

Organization Active NPI

Shelby Pediatric Associates and Child Lung Center PC

  • Pediatrics Physician
  • Shelby Township, MI
National Provider Identifier
1124051990
Registry record updated Mar 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
AR2460549 Issued in MI
Legal business name
SHELBY PEDIATRIC ASSOCIATES AND CHILD LUNG CENTER PC
Practice address
15125 22 Mile Rd
Shelby Township, MI 48315-4406
Phone
(586) 532-0599
Fax
(586) 566-8967
NPI assigned
Jul 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2024

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

Authorized official

Name
Maria Pellerito
Title
Office Manager
Phone
(586) 532-0599

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X AR2460549 MI Primary

Addresses

Primary practice location

15125 22 Mile Rd
Shelby Township, MI 48315-4406

Mailing address

15125 22 Mile Rd
Shelby Township, MI 48315-4406
Phone (586) 532-0599

Other identifiers 3

IdentifierTypeStateIssuer
4669589MedicaidMI
4432864MedicaidMI
4432882MedicaidMI

National Provider Directory

National Provider Directory

Locations

36555 26 Mile Rd
Ste 2100
Lenox, MI 48048
Phone (586) 532-0599

15125 22 Mile Rd
Shelby Township, MI 48315
Phone (586) 532-0599

Practitioners & affiliated clinicians

Practitioners 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711497600000",
    "number": "1124051990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15125 22 MILE RD",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483154406",
            "telephone_number": "586-532-0599",
            "fax_number": "586-566-8967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15125 22 MILE RD",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483154406",
            "telephone_number": "586-532-0599",
            "fax_number": "586-566-8967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELBY PEDIATRIC ASSOCIATES AND CHILD LUNG CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-27",
        "status": "A",
        "authorized_official_last_name": "PELLERITO",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "586-532-0599"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "AR2460549",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4669589",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4432864",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4432882",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby Township, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2024; 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.