NPIMap

Organization Active NPI

Ascension Providence Hospital

  • Psychologist
  • Southfield, MI
National Provider Identifier
1528023587
Registry record updated Jun 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
ASCENSION PROVIDENCE HOSPITAL
Practice address
16001 W 9 Mile Rd
Southfield, MI 48075-4818
Phone
(248) 849-3000
Fax
(248) 849-2244
NPI assigned
Apr 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2022

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

Authorized official

Name
Sarah Starkel
Title
Credentialing Coordinator
Phone
(248) 680-8121

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

16001 W 9 Mile Rd
Southfield, MI 48075-4818

Mailing address

28000 Dequindre Rd
Warren, MI 48092-2468
Phone (248) 680-8000

Other identifiers 1

IdentifierTypeStateIssuer
680F371930OtherMIMI BLUE CROSS GROUP PIN #

Other names 1

  • PH Psychology PhD/Providence Hospital and Medical Centers Inc Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656374400000",
    "number": "1528023587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28000 DEQUINDRE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480922468",
            "telephone_number": "248-680-8000",
            "fax_number": "248-292-3852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16001 W 9 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754818",
            "telephone_number": "248-849-3000",
            "fax_number": "248-849-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASCENSION PROVIDENCE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A",
        "authorized_official_last_name": "STARKEL",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "248-680-8121"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI BLUE CROSS GROUP PIN #",
            "identifier": "680F371930",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PH Psychology PhD/Providence Hospital and Medical Centers Inc",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "PH Psychology PhD/Providence Hospital and Medical Centers Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2022; 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.