NPIMap

Organization Active NPI

Primecare Urgent Care PLLC

  • Urgent Care Clinic/Center
  • Novi, MI
National Provider Identifier
1174875140
Registry record updated Dec 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
PRIMECARE URGENT CARE PLLC
Practice address
39555 W 10 Mile Rd
Suite 301
Novi, MI 48375-2950
Phone
(248) 426-7200
NPI assigned
Oct 15, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2013

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

Authorized official

Name
Theodore Shively, D.ONPI 1780666461
Title
Owner
Phone
(248) 755-2274

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 Primary

Addresses

Primary practice location

39555 W 10 Mile Rd
Suite 301
Novi, MI 48375-2950

Mailing address

39555 W 10 Mile Rd
Suite 301
Novi, MI 48375-2950

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140102001343 MI Part B Supplier - Clinic/Group Practice 7719115476 Receives reassigned benefits from 8 practitioners
Practice locations: Novi, MI

National Provider Directory

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.

NPI Registry JSON

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

{
    "created_epoch": "1350259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386720000000",
    "number": "1174875140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39555 W 10 MILE RD",
            "address_2": "SUITE 301",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483752950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39555 W 10 MILE RD",
            "address_2": "SUITE 301",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483752950",
            "telephone_number": "248-426-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMECARE URGENT CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-15",
        "last_updated": "2013-12-11",
        "status": "A",
        "authorized_official_last_name": "SHIVELY",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-755-2274",
        "authorized_official_credential": "D.O"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Novi, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2013; 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.