NPIMap

Organization Active NPI

St. Clair Orthopaedics and Sports Medicine PC

  • Orthopaedic Surgery Physician
  • Saint Clair Shores, MI
National Provider Identifier
1215570171
Registry record updated Oct 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
ST. CLAIR ORTHOPAEDICS AND SPORTS MEDICINE PC
Practice address
23829 Little Mack Ave Ste 100
Saint Clair Shores, MI 48080-1186
Phone
(586) 552-4573
NPI assigned
Oct 23, 2019
Last updated
Oct 23, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2019

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

Authorized official

Name
Elaine Russette
Title
Assistant Manager
Phone
(586) 552-4573

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X Primary

Addresses

Primary practice location

23829 Little Mack Ave Ste 100
Saint Clair Shores, MI 48080-1186

Mailing address

23829 Little Mack Ave Ste 100
Saint Clair Shores, MI 48080-1186
Phone (586) 552-4573

National Provider Directory

National Provider Directory
Tax ID family
St Clair Orthopaedics and Sports Medicine PC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1571788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571788800000",
    "number": "1215570171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23829 LITTLE MACK AVE STE 100",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801186",
            "telephone_number": "586-552-4573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23829 LITTLE MACK AVE STE 100",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801186",
            "telephone_number": "586-552-4573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CLAIR ORTHOPAEDICS AND SPORTS MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-23",
        "last_updated": "2019-10-23",
        "status": "A",
        "authorized_official_last_name": "RUSSETTE",
        "authorized_official_first_name": "ELAINE",
        "authorized_official_title_or_position": "ASSISTANT MANAGER",
        "authorized_official_telephone_number": "586-552-4573"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Oct 23, 2019; 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.