Organization Active NPI

Pine Knob Urgent Care PLLC

  • Urgent Care Clinic/Center
  • Clarkston, MI
National Provider Identifier
1144694571
Registry record updated Jul 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
PINE KNOB URGENT CARE PLLC
Practice address
6310 Sashabaw Rd
Suite C
Clarkston, MI 48346-2270
Phone
(810) 262-9020
Fax
(810) 715-5005
NPI assigned
Nov 23, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2016

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

Authorized official

Name
Scott Bonzheim, PA-CNPI 1255386900
Title
Partner
Phone
(810) 262-9020

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
Urgent Care Clinic/Center 261QU0200X MI Primary

Addresses

Primary practice location

6310 Sashabaw Rd
Suite C
Clarkston, MI 48346-2270

Mailing address

6310 Sashabaw Rd
Suite C
Clarkston, MI 48346-2270

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160503000345 MI Part B Supplier - Clinic/Group Practice 8921307554 Receives reassigned benefits from 15 practitioners
Practice locations: Clarkston, MI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2110933Pine Knob Urgent Care6310 Sashabaw Road Suite C, Clarkston, MI 48346Certificate of waiverMar 27, 2028

National Provider Directory

National Provider Directory

Locations

6310 Sashabaw Rd
Ste C
Clarkston, MI 48346
Phone (248) 297-5282

6310 Sashabaw Rd
Clarkston, MI 48346
Phone (248) 297-5282

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1448236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467676800000",
    "number": "1144694571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6310 SASHABAW RD",
            "address_2": "SUITE C",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483462270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6310 SASHABAW RD",
            "address_2": "SUITE C",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483462270",
            "telephone_number": "810-262-9020",
            "fax_number": "810-715-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE KNOB URGENT CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-23",
        "last_updated": "2016-07-05",
        "status": "A",
        "authorized_official_last_name": "BONZHEIM",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "810-262-9020",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarkston, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.