NPIMap

Organization Active NPI

Digestive Disease Consultants, PC

  • Gastroenterology Physician
  • Pontiac, MI
National Provider Identifier
1124179924
Registry record updated Sep 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
DIGESTIVE DISEASE CONSULTANTS, PC
Practice address
44555 Woodward Ave
Suite 304
Pontiac, MI 48341-5031
Phone
(248) 858-3878
Fax
(248) 209-6777
NPI assigned
Jan 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2021

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

Authorized official

Name
Kimberly Metheny, RN
Title
Office Manager
Phone
(248) 858-3878

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

44555 Woodward Ave
Suite 304
Pontiac, MI 48341-5031

Mailing address

44555 Woodward Ave
Suite 304
Pontiac, MI 48341-5031
Phone (248) 858-3878

Other identifiers 1

IdentifierTypeStateIssuer
100F316670OtherMIBLUE CROSS BLUE SHEILD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100115000882 MI Part B Supplier - Clinic/Group Practice 3678615473 Receives reassigned benefits from 3 practitioners
Practice locations: Pontiac, MI

National Provider Directory

National Provider Directory

Locations

44555 Woodward Ave
Ste 304
Pontiac, MI 48341
Phone (248) 858-3878

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/2ed1c574-c5ac-427e-a2ed-e9f8b5471f70/

Practitioners & affiliated clinicians

Practitioners 6

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": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631664000000",
    "number": "1124179924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44555 WOODWARD AVE",
            "address_2": "SUITE 304",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483415031",
            "telephone_number": "248-858-3878",
            "fax_number": "248-209-6777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44555 WOODWARD AVE",
            "address_2": "SUITE 304",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483415031",
            "telephone_number": "248-858-3878",
            "fax_number": "248-209-6777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIGESTIVE DISEASE CONSULTANTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A",
        "authorized_official_last_name": "METHENY",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "248-858-3878",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "100F316670",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pontiac, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; 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.