NPIMap

Organization Active NPI

William Beauont Hospital

Doing business as Beaumont Professional Services/Gastroenterology

  • Gastroenterology Physician
  • Royal Oak, MI
National Provider Identifier
1386693505
Registry record updated Oct 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
WILLIAM BEAUONT HOSPITAL
Doing business as
Beaumont Professional Services/Gastroenterology
Practice address
3601 W 13 Mile Rd
400 FSC PCS
Royal Oak, MI 48073-6712
Phone
(248) 423-2454
NPI assigned
May 6, 2006
Last updated
Oct 1, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
WILLIAM BEAUMONT HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 1, 2021

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

Authorized official

Name
Lee Ann Odom
Title
President Shared Services
Phone
(947) 522-3326

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X NU Primary

Addresses

Primary practice location

3601 W 13 Mile Rd
400 FSC PCS
Royal Oak, MI 48073-6712

Mailing address

26901 Beaumont Blvd
Compliance
Southfield, MI 48033-3849
Phone (947) 522-1964

Other identifiers 1

IdentifierTypeStateIssuer
0F36152OtherMIBCBSM

Other names 1

  • BEAUMONT PROFESSIONAL SERVICES/GASTROENTEROLOGY Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.beaumont.edu
Direct Messaging Address direct@direct.beaumont.edu

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031104000279 MI Part B Supplier - Clinic/Group Practice 9335051093 Receives reassigned benefits from 153 practitioners
42 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Royal Oak, MI; West Bloomfield, MI; Warren, MI; Troy, MI; Sterling Heights, MI; St Clair Shores, MI; Southfield, MI; Shelby Township, MI…

Other NPIs on the same Medicare enrollment 35

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

View all 35

National Provider Directory

National Provider Directory
Tax ID family
William Beaumont Hospital118 organizations share this tax ID, including this one
Part of
William Beaumont Hospital

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 1

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": "1146873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633046400000",
    "number": "1386693505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD",
            "address_2": "COMPLIANCE",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849",
            "telephone_number": "947-522-1964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 W 13 MILE RD",
            "address_2": "400 FSC PCS",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736712",
            "telephone_number": "248-423-2454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM BEAUONT HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILLIAM BEAUMONT HOSPITAL",
        "enumeration_date": "2006-05-06",
        "last_updated": "2021-10-01",
        "certification_date": "2021-10-01",
        "status": "A",
        "authorized_official_last_name": "ODOM",
        "authorized_official_first_name": "LEE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT SHARED SERVICES",
        "authorized_official_telephone_number": "947-522-3326"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0F36152",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "3601 W 13 Mile Rd",
            "city": "Royal Oak",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480736712",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "3601 W 13 Mile Rd",
            "address_2": "400 FSC PCS",
            "city": "Royal Oak",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480736712",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "BEAUMONT PROFESSIONAL SERVICES/GASTROENTEROLOGY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BEAUMONT PROFESSIONAL SERVICES/GASTROENTEROLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Royal Oak, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2021; 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.