NPIMap

Organization Active NPI

Henry Ford Health St. John Hospital

Doing business as Henry Ford St. John Hospital

  • Otolaryngology Physician
  • Saint Clair Shores, MI
National Provider Identifier
1376820605
Registry record updated May 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
HENRY FORD HEALTH ST. JOHN HOSPITAL
Doing business as
Henry Ford St. John Hospital
Lakeshore ENT Center
Practice address
21000 E 12 Mile Rd Ste 111
Saint Clair Shores, MI 48081-1156
Phone
(586) 779-7610
Fax
(586) 779-0031
NPI assigned
Nov 15, 2011
Last updated
May 19, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2026

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

Authorized official

Name
Kimberly Cebalt
Title
Director
Phone
(313) 874-6764

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology (Internal Medicine) Physician 207RA0201X MI
Otolaryngology Physician 207Y00000X MI Primary
Pediatric Otolaryngology Physician 207YP0228X MI
Facial Plastic Surgery Physician 207YS0123X MI
Plastic Surgery within the Head & Neck (Otolaryngology) Physician 207YX0007X MI
Otology & Neurotology Physician 207YX0901X MI
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X MI

Addresses

Primary practice location

21000 E 12 Mile Rd Ste 111
Saint Clair Shores, MI 48081-1156

Mailing address

PO Box 670884
Detroit, MI 48267-0884

Other names 2

  • Henry Ford St. John Hospital Doing business as
  • Lakeshore ENT Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040115000409 MI Part B Supplier - Clinic/Group Practice 3173424082 Receives reassigned benefits from 544 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

17900 23 Mile Rd
Ste 203
Macomb, MI 48044
Phone (586) 263-7400

1202 Walton Blvd
Ste 201
Rochester Hills, MI 48307
Phone (248) 652-0044

Practitioners & affiliated clinicians

Practitioners 35

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 35

NPI Registry JSON

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

{
    "created_epoch": "1321315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779148800000",
    "number": "1376820605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 670884",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482670884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21000 E 12 MILE RD STE 111",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811156",
            "telephone_number": "586-779-7610",
            "fax_number": "586-779-0031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENRY FORD HEALTH ST. JOHN HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-15",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A",
        "authorized_official_last_name": "CEBALT",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "313-874-6764"
    },
    "taxonomies": [
        {
            "code": "207RA0201X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Allergy & Immunology",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MI",
            "license": null,
            "primary": true
        },
        {
            "code": "207YP0228X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Pediatric Otolaryngology",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "207YX0901X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "MI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Henry Ford St. John Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lakeshore ENT Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lakeshore ENT Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2026; 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.