NPIMap

Organization Active NPI

St Clair Shores Obstetrics and Gynecolgy, PLC

Doing business as Shores OB/GYN

  • Obstetrics & Gynecology Physician
  • Saint Clair Shores, MI
National Provider Identifier
1164535886
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
ST CLAIR SHORES OBSTETRICS AND GYNECOLGY, PLC
Doing business as
Shores OB/GYN
Practice address
19714 E 10 Mile Rd
Saint Clair Shores, MI 48080-1064
Phone
(586) 779-9400
Fax
(586) 779-8949
NPI assigned
Aug 16, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Constantine Raphtis, D.O.NPI 1558354159
Title
Member
Phone
(586) 779-9400

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
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

19714 E 10 Mile Rd
Saint Clair Shores, MI 48080-1064

Mailing address

19714 Ten Mile Road
St Clair Shores, MI 48080
Phone (586) 779-9400

Other names 1

  • Shores OB/GYN Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040914000287 MI Part B Supplier - Clinic/Group Practice 9638146251 Receives reassigned benefits from 6 practitioners
Practice locations: Macomb, MI; Saint Clair Shores, MI

National Provider Directory

National Provider Directory
Tax ID family
Shores OBGYN2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 9

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": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164535886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19714 TEN MILE ROAD",
            "city": "ST CLAIR SHORES",
            "state": "MI",
            "postal_code": "48080",
            "telephone_number": "586-779-9400",
            "fax_number": "586-779-8949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19714 E 10 MILE RD",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801064",
            "telephone_number": "586-779-9400",
            "fax_number": "586-779-8949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CLAIR SHORES OBSTETRICS AND GYNECOLGY, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RAPHTIS",
        "authorized_official_first_name": "CONSTANTINE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "586-779-9400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shores OB/GYN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.