NPIMap

Organization Active NPI

Judson Center, Inc.

Doing business as Judson Center Family Health Clinic

  • Family Medicine Physician
  • Warren, MI
National Provider Identifier
1396217600
Registry record updated Jun 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
JUDSON CENTER, INC.
Doing business as
Judson Center Family Health Clinic
Practice address
12200 E 13 Mile Rd
Warren, MI 48093-3093
Phone
(586) 573-1810
NPI assigned
Dec 27, 2018
Last updated
Jun 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2023

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

Authorized official

Name
Kristin C Desjardins
Title
Director of Reimbursement
Phone
(248) 554-6358

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

12200 E 13 Mile Rd
Warren, MI 48093-3093

Mailing address

4410 W 13 Mile Rd
Royal Oak, MI 48073-6515
Phone (586) 573-1810

Other names 1

  • Judson Center Family Health Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140331001580 MI Part B Supplier - Clinic/Group Practice 5698906907 Receives reassigned benefits from 14 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Warren, MI; Royal Oak, MI; Dearborn, MI

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Judson Center Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3 Parklane Blvd
Ste 730W
Dearborn, MI 48126
Phone (313) 794-5653

12200 E 13 Mile Rd
Warren, MI 48093
Phone (586) 573-1810

12200 E 13 Mile Rd
Ste 210
Warren, MI 48093
Phone (586) 573-1810

12220 E 13 Mile Rd
Warren, MI 48093
Phone (586) 573-1810

Practitioners & affiliated clinicians

Practitioners 65

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 65

NPI Registry JSON

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

{
    "created_epoch": "1545868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687305600000",
    "number": "1396217600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4410 W 13 MILE RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736515",
            "telephone_number": "586-573-1810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12200 E 13 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933093",
            "telephone_number": "586-573-1810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUDSON CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-27",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A",
        "authorized_official_last_name": "DESJARDINS",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DIRECTOR OF REIMBURSEMENT",
        "authorized_official_telephone_number": "248-554-6358"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Judson Center Family Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Warren, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2023; 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.