NPIMap

Organization Active NPI

Port Huron Vascular Clinic PC

  • Surgery Physician
  • Port Huron, MI
National Provider Identifier
1134166895
Registry record updated Apr 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
PORT HURON VASCULAR CLINIC PC
Practice address
2603 Electric Ave
Suite C
Port Huron, MI 48060-6588
Phone
(810) 985-1300
Fax
(810) 985-1659
NPI assigned
Jun 1, 2006
Last updated
Apr 23, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2014

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

Authorized official

Name
Sadiq Hussain, MDNPI 1730197195
Title
President
Phone
(810) 985-1300

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X Primary
Vascular Surgery Physician 2086S0129X

Addresses

Primary practice location

2603 Electric Ave
Suite C
Port Huron, MI 48060-6588

Mailing address

2603 Electric Ave
Suite C
Port Huron, MI 48060-6588
Phone (810) 985-1300

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060825000050 MI Part B Supplier - Clinic/Group Practice 3173526548 Receives reassigned benefits from 2 practitioners
Practice locations: Port Huron, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398211200000",
    "number": "1134166895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2603 ELECTRIC AVE",
            "address_2": "SUITE C",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480606588",
            "telephone_number": "810-985-1300",
            "fax_number": "810-985-1659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2603 ELECTRIC AVE",
            "address_2": "SUITE C",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480606588",
            "telephone_number": "810-985-1300",
            "fax_number": "810-985-1659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT HURON VASCULAR CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2014-04-23",
        "status": "A",
        "authorized_official_last_name": "HUSSAIN",
        "authorized_official_first_name": "SADIQ",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "810-985-1300",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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 Apr 23, 2014; 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.