Organization Active NPI

Riverside Medical Associates, P.C.

  • Family Medicine Physician
  • Sault Sainte Marie, MI
National Provider Identifier
1306832605
Registry record updated Jul 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
RIVERSIDE MEDICAL ASSOCIATES, P.C.
Practice address
560 Osborn Blvd
Sault Sainte Marie, MI 49783-1883
Phone
(906) 632-1800
Fax
(906) 632-2199
NPI assigned
Sep 22, 2005
Last updated
Jul 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2022

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

Authorized official

Name
Kellie L Popour
Title
Manager
Phone
(906) 632-2004

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

560 Osborn Blvd
Sault Sainte Marie, MI 49783-1883

Mailing address

560 Osborn Blvd
Sault Sainte Marie, MI 49783-1883
Phone (906) 632-2004

Other identifiers 1

IdentifierTypeStateIssuer
0A76352OtherMIBCBSM

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1127347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657670400000",
    "number": "1306832605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 OSBORN BLVD",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497831883",
            "telephone_number": "906-632-2004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 OSBORN BLVD",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497831883",
            "telephone_number": "906-632-1800",
            "fax_number": "906-632-2199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE MEDICAL ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-22",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A",
        "authorized_official_last_name": "POPOUR",
        "authorized_official_first_name": "KELLIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "906-632-2004"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0A76352",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sault Sainte Marie, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2022; 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.