Olivia Rose Souphis, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301509134 Issued in MI

Practice address

309 E 11 Mile Rd
Royal Oak, MI 48067-2735

Phone

(947) 522-4900

NPI assigned

Apr 20, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Central Michigan College of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oakwood Ambulatory LLCGroup PAC ID 1850282914, 271 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130
• Beaumont Hospital, Troy Hospital, Troy, MI, CCN 230269

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: osouphis1256974@epic00.shdirect.org
• Direct secure messaging: osouphis1467398@direct.beaumont.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oakwood Ambulatory LLC

  • Internal Medicine Physician
  • Dearborn, MI
  • NPI 1003829441

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Oakwood Ambulatory, LLC

  • Podiatrist
  • Westland, MI
  • NPI 1013157361
  NPD
• William Beaumont Hospital

  • Physician Assistant
  • Royal Oak, MI
  • NPI 1164471983
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• William Beaumont Hospital

  • General Acute Care Hospital
  • Troy, MI
  • NPI 1306825997
  Care Compare affiliation
• William Beaumont Hospital

  • General Acute Care Hospital
  • Royal Oak, MI
  • NPI 1689653305
  Care Compare affiliation
• William Beaumont Hospital

  • General Acute Care Hospital
  • Grosse Pointe, MI
  • NPI 1932396017
  Care Compare affiliation

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

{
    "created_epoch": "1587340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692230400000",
    "number": "1356961361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 E 11 MILE RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480672735",
            "telephone_number": "947-522-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUPHIS",
        "first_name": "OLIVIA",
        "middle_name": "ROSE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-20",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301509134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "osouphis1467398@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "309 E 11 Mile Rd",
            "city": "Royal Oak",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480672735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Maya Soufan, MBBS
• Dana Soukup, MD
• Stephen J Soules
• Soulspace Wellness Center
• Maria Kathryn Souphis, DO
• Ravikumar Sourirajan, PT, DPT
• Marcy Lee Soutar, RN
• Southeast Michigan Neurosurgery PLLC
• Jacob Brad Souva
• Aimee Christine Sova, LLMSW

• Family Medicine Physician in Royal Oak, MI
• Providers in Royal Oak, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.