NPIMap

Organization Active NPI

Primecare of Novi PLLC

  • Family Medicine Physician
  • Novi, MI
National Provider Identifier
1235281916
Registry record updated Jan 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PRIMECARE OF NOVI PLLC
Practice address
39555 West Ten Mile Rd
Suite 302
Novi, MI 48375-2950
Phone
(248) 426-7200
Fax
(248) 426-7335
NPI assigned
Jan 16, 2007
Last updated
Jan 25, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2010

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

Authorized official

Name
Theodore W Shively, D.O.NPI 1780666461
Title
Member
Phone
(248) 426-7200

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
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

39555 West Ten Mile Rd
Suite 302
Novi, MI 48375-2950

Mailing address

39555 West Ten Mile Rd
Suite 302
Novi, MI 48375-2950
Phone (248) 426-7200

Other identifiers 1

IdentifierTypeStateIssuer
0F316970OtherMIBLUE CROSS BLUE SHIELD MI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040212000644 MI Part B Supplier - Clinic/Group Practice 2264326883 Receives reassigned benefits from 10 practitioners
Practice locations: Novi, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264377600000",
    "number": "1235281916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39555 WEST TEN MILE RD",
            "address_2": "SUITE 302",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483752950",
            "telephone_number": "248-426-7200",
            "fax_number": "248-426-7335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39555 WEST TEN MILE RD",
            "address_2": "SUITE 302",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483752950",
            "telephone_number": "248-426-7200",
            "fax_number": "248-426-7335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMECARE OF NOVI PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2010-01-25",
        "status": "A",
        "authorized_official_last_name": "SHIVELY",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "248-426-7200",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MI",
            "identifier": "0F316970",
            "state": "MI"
        }
    ],
    "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 Jan 25, 2010; 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.