NPIMap

Individual provider Active NPI

Mirjana Dimitrijevic, MD

  • Internal Medicine Physician
  • Roseville, MI
National Provider Identifier
1437413168
Registry record updated Jun 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
L2258453 Issued in MI
Practice address
18001 E 10 Mile Rd
Roseville, MI 48066
Phone
(586) 218-5800
Fax
(586) 218-5808
NPI assigned
Jun 27, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X L2258453 MI Primary

Addresses

Primary practice location

18001 E 10 Mile Rd
Roseville, MI 48066

Mailing address

18001 E 10 Mile Rd
Roseville, MI 48066-3803
Phone (586) 218-5800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150915002484 MI Practitioner - NephrologyPractitioner - Internal Medicine 7810204450 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Clair Specialty Physicians PCGroup PAC ID 6204733256, 36 clinicians

Practice addresses (Care Compare)

18001 E 10 Mile Rd
Roseville, MI 48066-3983
Phone (586) 218-5800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
L2258453MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Clair Specialty Physicians PC Nephrology CurrentSince Aug 1, 2018 Accepting new patients
Henry Ford Health St. John Hospital Past Accepting new patients

Locations

22201 Moross Rd
Ste 170
Detroit, MI 48236
Phone (313) 886-8787

18001 E 10 Mile Rd
Roseville, MI 48066

23857 Greenfield Rd
Southfield, MI 48075
Phone (248) 569-6111

45640 Schoenherr Rd
Ste B
Utica, MI 48315
Phone (586) 247-4300

Interoperability endpoints

  • Direct secure messaging: mdimitrijevic1125282@direct.hfhs.org
  • Direct secure messaging: mdimitrijevic548579@direct.hfhs.org
  • Direct secure messaging: mirjanadimitrijevic@stclairspe.allscriptsdirect.net

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1340755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528243200000",
    "number": "1437413168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18001 E 10 MILE RD",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480663803",
            "telephone_number": "586-218-5800",
            "fax_number": "586-218-5808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18001 E 10 MILE RD",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "48066",
            "telephone_number": "586-218-5800",
            "fax_number": "586-218-5808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIMITRIJEVIC",
        "first_name": "MIRJANA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-27",
        "last_updated": "2018-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "L2258453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MI

Sources for this page

Verify at the official NPI Registry.