Oakland Gastroenterology Associates, P.C.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

4301044285 Issued in MI

Legal business name

OAKLAND GASTROENTEROLOGY ASSOCIATES, P.C.

Practice address

3535 W 13 Mile Rd
Suite 202
Royal Oak, MI 48073-6770

Phone

(248) 551-0900

Fax

(248) 551-0905

NPI assigned

Sep 21, 2006

Last updated

May 5, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Gregg Polidori, M.D.NPI 1689665465

Title

President

Phone

(248) 551-0900

Specialties & licenses 1

Addresses

Other identifiers 13

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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.

• Gregg Polidori, MD

  • Gastroenterology Physician
  • Royal Oak, MI
  • NPI 1689665465
  Medicare reassignment Care Compare group NPD Authorized official
• Sami Akkary, M.D

  • Gastroenterology Physician
  • Southfield, MI
  • NPI 1720199938
  Medicare reassignment Care Compare group NPD
• Robert H Goo, MD

  • Gastroenterology Physician
  • W Bloomfield, MI
  • NPI 1760473540
  Medicare reassignment Care Compare group NPD
• Dorene K Hardie-Goo, NP

  • Nurse Practitioner
  • West Bloomfield, MI
  • NPI 1649545955
  Medicare reassignment NPD
• Richard Shawn Kinsey, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Memphis, TN
  • NPI 1659574127

  MI

  Medicare reassignment NPD
• Ehab Rabaa, M.D.

  • Anatomic Pathology Physician
  • Memphis, TN
  • NPI 1164586707

  MI

  Medicare reassignment NPD
• Tusar K Desai, MD

  • Gastroenterology Physician
  • Saginaw, MI
  • NPI 1740271527
  NPD

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399248000000",
    "number": "1508964511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 W 13 MILE RD",
            "address_2": "SUITE 202",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736770",
            "telephone_number": "248-551-0900",
            "fax_number": "248-551-0905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 W 13 MILE RD",
            "address_2": "SUITE 202",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736770",
            "telephone_number": "248-551-0900",
            "fax_number": "248-551-0905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAKLAND GASTROENTEROLOGY ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2014-05-05",
        "status": "A",
        "authorized_official_last_name": "POLIDORI",
        "authorized_official_first_name": "GREGG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-551-0900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MI",
            "license": "4301044285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS AND BCN",
            "identifier": "100F37143",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4101048",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4310182",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2836211",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4257370",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3364901",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4258298",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4257380",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4340978",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4340940",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4592984",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2836230",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4318636",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian James O'Neil, M.D.
• Chelsea Rose O'Neill, FNP
• Lisa O'Sullivan
• Oakland Colon & Rectal Assoc P C
• Oakland Family Services
• Oakland Medical Clinic PLLC
• Oakland Medical Group PC
• Oakland Medical Services, P.C. (The Rontal Clinic;The Rontal Clinic, PC,The Rontal-Akervall Clinic)
• Oakland Neurologists, P.C.
• Oakland Neurosurgical Associates, PC

• Gastroenterology Physician in Royal Oak, MI
• Providers in Royal Oak, MI by specialty
• Gastroenterology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.