NPIMap

Organization Active NPI

A3 Medical

  • Internal Medicine Physician
  • Bloomfield, MI
National Provider Identifier
1366798373
Registry record updated Oct 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301080609 Issued in MI
Legal business name
A3 MEDICAL
Practice address
4050 W Maple Road
Suite 101
Bloomfield, MI 48301
Phone
(248) 885-8211
Fax
(248) 855-8357
NPI assigned
Jul 27, 2012
Last updated
Oct 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2022

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

Authorized official

Name
Supak Sookkasikon, MDNPI 1649376922
Title
Not Applicable
Phone
(248) 885-8211

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X NU
Family Medicine Physician 207Q00000X 4301083253 MI
Internal Medicine Physician 207R00000X 4301080609 MI Primary

Addresses

Primary practice location

4050 W Maple Road
Suite 101
Bloomfield, MI 48301

Mailing address

4050 W Maple Road
Suite 101
Bloomfield, MI 48301
Phone (248) 885-8211

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130425000025 MI Part B Supplier - Clinic/Group Practice 7315183076 Receives reassigned benefits from 6 practitioners
Practice locations: Bloomfield Hills, MI; Northville, MI

National Provider Directory

National Provider Directory

Locations

4050 W Maple Rd
Ste 101
Bloomfld Hls, MI 48301
Phone (248) 385-3412

20490 Haggerty Rd
Northville Township, MI 48167
Phone (248) 885-8821

2140 E 12 Mile Rd
Royal Oak, MI 48067
Phone (248) 885-8211

Interoperability endpoints

  • Direct secure messaging: abbymorgan@emcuramed.allscriptsdirect.net
  • Direct secure messaging: allisonkunz@emcuramed.allscriptsdirect.net
  • Direct secure messaging: angeliczaitouna@emcuramed.allscriptsdirect.net
  • Direct secure messaging: faraazsiddiqui@emcuramed.allscriptsdirect.net
  • Direct secure messaging: jennahviau@emcuramed.allscriptsdirect.net
  • Direct secure messaging: jenniferruel@emcuramed.allscriptsdirect.net
  • Direct secure messaging: juliamcaree@emcuramed.allscriptsdirect.net
  • Direct secure messaging: juliekoelzer@emcuramed.allscriptsdirect.net
  • Direct secure messaging: katecvetkovski@emcuramed.allscriptsdirect.net
  • Direct secure messaging: kelseymcdonald@emcuramed.allscriptsdirect.net
  • Direct secure messaging: malloryhudson@emcuramed.allscriptsdirect.net
  • Direct secure messaging: manishkesliker@emcuramed.allscriptsdirect.net
  • Direct secure messaging: marcelamarsh@emcuramed.allscriptsdirect.net
  • Direct secure messaging: matthewbach@emcuramed.allscriptsdirect.net
  • Direct secure messaging: michaelhughes@emcuramed.allscriptsdirect.net
  • Direct secure messaging: nataliekase@emcuramed.allscriptsdirect.net
  • Direct secure messaging: serenasherry@emcuramed.allscriptsdirect.net
  • Direct secure messaging: shelbybrewington@emcuramed.allscriptsdirect.net
  • Direct secure messaging: shelbymorgan@emcuramed.allscriptsdirect.net
  • Direct secure messaging: snehabency@emcuramed.allscriptsdirect.net

Practitioners & affiliated clinicians

Practitioners 37

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.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1343347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665705600000",
    "number": "1366798373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4050 W MAPLE ROAD",
            "address_2": "SUITE 101",
            "city": "BLOOMFIELD",
            "state": "MI",
            "postal_code": "48301",
            "telephone_number": "248-885-8211",
            "fax_number": "248-855-8357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4050 W MAPLE ROAD",
            "address_2": "SUITE 101",
            "city": "BLOOMFIELD",
            "state": "MI",
            "postal_code": "48301",
            "telephone_number": "248-885-8211",
            "fax_number": "248-855-8357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A3 MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-27",
        "last_updated": "2022-10-14",
        "certification_date": "2022-10-14",
        "status": "A",
        "authorized_official_last_name": "SOOKKASIKON",
        "authorized_official_first_name": "SUPAK",
        "authorized_official_title_or_position": "NOT APPLICABLE",
        "authorized_official_telephone_number": "248-885-8211",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301083253",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301080609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; 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.