NPIMap

Organization Active NPI

William Beaumont Hospitals

  • Nurse Practitioner
  • Royal Oak, MI
National Provider Identifier
1194774919
Registry record updated Oct 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
WILLIAM BEAUMONT HOSPITALS
Practice address
3601 W 13 Mile Rd
Royal Oak, MI 48073-6712
Phone
(248) 423-2454
NPI assigned
May 9, 2006
Organization subpart
Yes
Parent organization
WILLIAM BEAUMONT HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 1, 2021

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

Authorized official

Name
Lee Ann Odom
Title
President Shared Services
Phone
(947) 522-3326

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712

Mailing address

26901 Beaumont Blvd
Compliance
Southfield, MI 48033-3842
Phone (947) 522-1964

Other identifiers 1

IdentifierTypeStateIssuer
0F31819OtherMIBCBSM

Other names 1

  • BEAUMONT PROFESSIONAL SERVICES/NURSE PRACTIONER Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.beaumont.edu
Direct Messaging Address direct@direct.beaumont.edu

National Provider Directory

National Provider Directory
Tax ID family
William Beauont Hospital118 organizations share this tax ID, including this one
Part of
William Beauont Hospital

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 2

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": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633046400000",
    "number": "1194774919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD",
            "address_2": "COMPLIANCE",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333842",
            "telephone_number": "947-522-1964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 W 13 MILE RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736712",
            "telephone_number": "248-423-2454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM BEAUMONT HOSPITALS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILLIAM BEAUMONT HOSPITAL",
        "enumeration_date": "2006-05-09",
        "last_updated": "2021-10-01",
        "certification_date": "2021-10-01",
        "status": "A",
        "authorized_official_last_name": "ODOM",
        "authorized_official_first_name": "LEE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT SHARED SERVICES",
        "authorized_official_telephone_number": "947-522-3326"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0F31819",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "3601 W 13 Mile Rd",
            "address_2": "400 FSC PCS",
            "city": "Royal Oak",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480736712",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "3601 W 13 Mile Rd",
            "city": "Royal Oak",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480736712",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "BEAUMONT PROFESSIONAL SERVICES/NURSE PRACTIONER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BEAUMONT PROFESSIONAL SERVICES/NURSE PRACTIONER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Royal Oak, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.