Michigan Endoscopy Center at Providence Park

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

MICHIGAN ENDOSCOPY CENTER AT PROVIDENCE PARK

Practice address

47601 Grand River Ave Ste D-110
Novi, MI 48374-1233

Phone

(248) 465-9220

Fax

(248) 347-1915

NPI assigned

May 22, 2013

Last updated

Nov 4, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Cristin Trahey

Title

Administrator

Phone

(248) 465-9220

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Listed as

Michigan Endoscopy Center at Providence ParkCCN 23C0001120

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Henry Ford Health Providence Hospital

  dba Henry Ford Providence Hospital

  • Certified Registered Nurse Anesthetist
  • Southfield, MI
  • NPI 1851339196

  Member Of

  NPD member
• Michigan Endoscopy Center LLC

  • Ambulatory Surgical Clinic/Center
  • Farmington Hills, MI
  • NPI 1629075106

  Member Of

  NPD member

Locations

Practitioners 1

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.

• Janice M Fields, MD

  • Gastroenterology Physician
  • Farmington Hills, MI
  • NPI 1346223609
  NPD (past)

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

{
    "created_epoch": "1369180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762214400000",
    "number": "1306283957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47601 GRAND RIVER AVE STE D-110",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483741233",
            "telephone_number": "248-465-9220",
            "fax_number": "248-347-1915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47601 GRAND RIVER AVE STE D-110",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483741233",
            "telephone_number": "248-465-9220",
            "fax_number": "248-347-1915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN ENDOSCOPY CENTER AT PROVIDENCE PARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-22",
        "last_updated": "2025-11-04",
        "certification_date": "2025-11-04",
        "status": "A",
        "authorized_official_last_name": "TRAHEY",
        "authorized_official_first_name": "CRISTIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "248-465-9220"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blaire E Michelin
• Gabriela Micheloni
• Michigan Cancer Center PC (DNS Hematology Oncology PC)
• Michigan Care Angels Inc
• Michigan Crnas Staffing LLC
• Michigan Eye and Contact Lens PLLC
• Michigan Fyzpt-I LLC
• Michigan Hand & Wrist, P.C.
• Michigan Hand and Wrist PC
• Michigan Health Care, Inc. (Elder Care)

• Ambulatory Surgical Clinic/Center in Novi, MI
• Providers in Novi, MI by specialty
• Ambulatory Surgical Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.