NPIMap

Organization Active NPI

Beaumont Health

  • Clinic/Center
  • Southgate, MI
National Provider Identifier
1497290456
Registry record updated Dec 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
4704208352 Issued in MI
Legal business name
BEAUMONT HEALTH
Practice address
15777 Northline
Southgate, MI 48195
Phone
(313) 570-7906
NPI assigned
Dec 30, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2016

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

Authorized official

Name
Diane Pearl, NPNPI 1417495524
Title
Nurse Practitioner
Phone
(313) 570-7906

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 4704208352 MI Primary

Addresses

Primary practice location

15777 Northline
Southgate, MI 48195

Mailing address

17801 Snow
Dearborn, MI 48124

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1483056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483056000000",
    "number": "1497290456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17801 SNOW",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "48124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15777 NORTHLINE",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "48195",
            "telephone_number": "313-570-7906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAUMONT HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-30",
        "last_updated": "2016-12-30",
        "status": "A",
        "authorized_official_last_name": "PEARL",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "313-570-7906",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MI",
            "license": "4704208352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southgate, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.