NPIMap

Organization Active NPI

Summit Regenerative Health

  • Chiropractor
  • Waterford, MI
National Provider Identifier
1518734797
Registry record updated Dec 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
SUMMIT REGENERATIVE HEALTH
Practice address
2801 Elizabeth Lake Rd Ste 100
Waterford, MI 48328-3281
Phone
(248) 683-6260
NPI assigned
Dec 7, 2023
Last updated
Dec 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2023

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

Authorized official

Name
Dr. Samuel A Gray, DCNPI 1992834535
Title
Owner
Phone
(248) 683-6260

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X
Chiropractor 111N00000X Primary
Neuromusculoskeletal Medicine & OMM Physician 204D00000X
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

2801 Elizabeth Lake Rd Ste 100
Waterford, MI 48328-3281

Mailing address

2801 Elizabeth Lake Rd Ste 100
Waterford, MI 48328-3281
Phone (248) 683-6260

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240417002766 MI Part B Supplier - Clinic/Group Practice 6406295849 Receives reassigned benefits from 6 practitioners
Practice locations: Waterford, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1701907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701907200000",
    "number": "1518734797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 ELIZABETH LAKE RD STE 100",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483283281",
            "telephone_number": "248-683-6260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 ELIZABETH LAKE RD STE 100",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483283281",
            "telephone_number": "248-683-6260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT REGENERATIVE HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-07",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-05",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-683-6260",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; 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.