NPIMap

Organization Active NPI

Southeastern Michigan Kidney Center PLLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Berkley, MI
National Provider Identifier
1316967797
Registry record updated Sep 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
SOUTHEASTERN MICHIGAN KIDNEY CENTER PLLC
Practice address
1695 W 12 Mile Rd
Suite 250
Berkley, MI 48072-2183
Phone
(248) 414-5200
Fax
(248) 414-5227
NPI assigned
Jul 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2011

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

Authorized official

Name
Mr. David F Shepherd
Title
Vice President
Phone
(248) 642-5038

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

1695 W 12 Mile Rd
Suite 250
Berkley, MI 48072-2183

Mailing address

30100 Telegraph Rd
Suite 200
Bingham Farms, MI 48025-4516
Phone (248) 723-0224

Other identifiers 15

IdentifierTypeStateIssuer
000000009371OtherCAPE
08981OtherBLUE CROSS PRIMARY
08981OtherFED BLUE CROSS PRIMARY
1022510001OtherWELLNESS
140042OtherCARE CHOICES
OP630345OtherM CARE
09499OtherBLUE CROSS SECONDARY
501076OtherULTI MED
567595OtherSELECTCARE
P117519OtherBLUE CARE NETWORK
140042OtherPREFERRED CHOICE
09499OtherFED BLUE CROSS SECONDARY
8203OtherGREATLAKES
232574OtherHAP
4112097MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111007000103 MI Part A Provider - End-Stage Renal Disease Facility (ESRD) 2567455652 Practice locations: Berkley, MI

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Southeast Michigan Kidney CenterCCN 232574
Overall star rating
2.0 of 5
Ownership
Profit
Certified
Jun 2, 1999
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Greenfield Health Systems
Dialysis stations
2

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317168000000",
    "number": "1316967797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30100 TELEGRAPH RD",
            "address_2": "SUITE 200",
            "city": "BINGHAM FARMS",
            "state": "MI",
            "postal_code": "480254516",
            "telephone_number": "248-723-0224",
            "fax_number": "248-642-7852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1695 W 12 MILE RD",
            "address_2": "SUITE 250",
            "city": "BERKLEY",
            "state": "MI",
            "postal_code": "480722183",
            "telephone_number": "248-414-5200",
            "fax_number": "248-414-5227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN MICHIGAN KIDNEY CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2011-09-28",
        "status": "A",
        "authorized_official_last_name": "SHEPHERD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "248-642-5038",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPE",
            "identifier": "000000009371",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PRIMARY",
            "identifier": "08981",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FED BLUE CROSS PRIMARY",
            "identifier": "08981",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLNESS",
            "identifier": "1022510001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE CHOICES",
            "identifier": "140042",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "M CARE",
            "identifier": "OP630345",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS SECONDARY",
            "identifier": "09499",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ULTI MED",
            "identifier": "501076",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SELECTCARE",
            "identifier": "567595",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "P117519",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CHOICE",
            "identifier": "140042",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FED BLUE CROSS SECONDARY",
            "identifier": "09499",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREATLAKES",
            "identifier": "8203",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAP",
            "identifier": "232574",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4112097",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkley, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; 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.