NPIMap

Organization Active NPI

Metro Medical Practice PC

  • Internal Medicine Physician
  • Troy, MI
National Provider Identifier
1427096064
Registry record updated Feb 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
TU034870 Issued in MI
Legal business name
METRO MEDICAL PRACTICE PC
Practice address
2891 E Maple Rd
Suite 102
Troy, MI 48083-6106
Phone
(248) 524-9085
Fax
(248) 524-9086
NPI assigned
Jun 4, 2006
Last updated
Feb 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2024

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

Authorized official

Name
Natalia Rutkovsky
Title
Office Menager
Phone
(248) 524-9085

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X TU034870 MI Primary

Addresses

Primary practice location

2891 E Maple Rd
Suite 102
Troy, MI 48083-6106

Mailing address

2891 E Maple Rd
Suite 102
Troy, MI 48083-6106
Phone (248) 524-9085

Other identifiers 1

IdentifierTypeStateIssuer
700F325720OtherMIBLUE CROSS BLUE SHIELD

Other names 1

  • Metro Medical Practice Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050408000783 MI Part B Supplier - Clinic/Group Practice 7214982784 Receives reassigned benefits from 7 practitioners
Practice locations: Troy, MI

National Provider Directory

National Provider Directory

Locations

2891 E Maple Rd
Ste 102
Troy, MI 48083
Phone (248) 524-9085

Practitioners & affiliated clinicians

Practitioners 7

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": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709164800000",
    "number": "1427096064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2891 E MAPLE RD",
            "address_2": "SUITE 102",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480836106",
            "telephone_number": "248-524-9085",
            "fax_number": "248-524-9086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2891 E MAPLE RD",
            "address_2": "SUITE 102",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480836106",
            "telephone_number": "248-524-9085",
            "fax_number": "248-524-9086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METRO MEDICAL PRACTICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A",
        "authorized_official_last_name": "RUTKOVSKY",
        "authorized_official_first_name": "NATALIA",
        "authorized_official_title_or_position": "OFFICE MENAGER",
        "authorized_official_telephone_number": "248-524-9085"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "TU034870",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "700F325720",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Metro Medical Practice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Troy, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2024; 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.