NPIMap

Organization Active NPI

St Clair Adult Medicine Specialists PC

  • Internal Medicine Physician
  • Saint Clair Shores, MI
National Provider Identifier
1508864620
Registry record updated Jul 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MH404922 Issued in MI
Legal business name
ST CLAIR ADULT MEDICINE SPECIALISTS PC
Practice address
23411 Jefferson Ave
Suite 100
Saint Clair Shores, MI 48080-1949
Phone
(586) 778-4080
Fax
(586) 778-6055
NPI assigned
Jul 12, 2005
Last updated
Jul 16, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2010

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

Authorized official

Name
Dr. Mary Beth Hardwicke, MD
Title
Owner/Physician
Phone
(586) 778-4080

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MH404922 MI Primary

Addresses

Primary practice location

23411 Jefferson Ave
Suite 100
Saint Clair Shores, MI 48080-1949

Mailing address

PO Box 673215
Detroit, MI 48267-3215
Phone (586) 778-4080

Other identifiers 6

IdentifierTypeStateIssuer
3384323MedicaidMI
4613977MedicaidMI
4989630MedicaidMI
110E010920OtherMIBCBS BCN
4240936MedicaidMI
3389123MedicaidMI

National Provider Directory

National Provider Directory

Locations

23501 Jefferson Ave
St Clr Shores, MI 48080
Phone (586) 863-5030

Practitioners & affiliated clinicians

Practitioners 9

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": "1121126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279238400000",
    "number": "1508864620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 673215",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482673215",
            "telephone_number": "586-778-4080",
            "fax_number": "586-778-6055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23411 JEFFERSON AVE",
            "address_2": "SUITE 100",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801949",
            "telephone_number": "586-778-4080",
            "fax_number": "586-778-6055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CLAIR ADULT MEDICINE SPECIALISTS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-12",
        "last_updated": "2010-07-16",
        "status": "A",
        "authorized_official_last_name": "HARDWICKE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "BETH",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "586-778-4080",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "MH404922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3384323",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4613977",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4989630",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS BCN",
            "identifier": "110E010920",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4240936",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3389123",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2010; 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.