Active NPI
Great Lakes Surgical Center LLC
- Ambulatory Surgical Clinic/Center
- Southfield, MI
National Provider Identifier
1568420388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Surgical Clinic/Center
- License
- 261QA1903X
- Legal business name
- GREAT LAKES SURGICAL CENTER LLC
- Practice address
- 26051 Lahser Rd
Southfield, MI 48034-2601 - Phone
- (248) 223-9925
- Fax
- (248) 223-9957
- NPI assigned
- May 2, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Keith M Metz, M.D.
- Title
- Medical Director
- Phone
- (248) 223-9925
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | 261QA1903X | MI | Primary |
Addresses
Primary practice location
26051 Lahser Rd
Southfield, MI 48034-2601
Mailing address
26051 Lahser Rd
Southfield, MI 48034-2601
Phone (248) 223-9925
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 490F328640 | Other | MI | BLUE CROSS SECONDARY |
| 17228 | Other | MI | MCARE |
| 40332 | Other | MI | BLUE CROSS PRIMARY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050801000756 | MI | Part B Supplier - Ambulatory Surgical Center | 0446288468 | Practice locations: Southfield, MI |
Care Compare: Ambulatory surgical center
Medicare Care Compare- Listed as
- Great Lakes Surgical Center LLC
- Medicare certification status
- Active
National Provider Directory
National Provider Directory- Tax ID family
- Great Lakes Surgical Center
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Ambulatory Surgical Clinic/Center
- Southfield, MI
- NPI 1265856231
Locations
26051 Lahser Rd
Southfield, MI 48033
Phone (248) 223-9925
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Anesthesiology Physician
- Detroit, MI
- NPI 1881638898
-
- Anesthesiology Physician
- Ann Arbor, MI
- NPI 1255452918
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146528000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1208649600000",
"number": "1568420388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26051 LAHSER RD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480342601",
"telephone_number": "248-223-9925",
"fax_number": "248-223-9957"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26051 LAHSER RD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480342601",
"telephone_number": "248-223-9925",
"fax_number": "248-223-9957"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GREAT LAKES SURGICAL CENTER LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-02",
"last_updated": "2008-04-20",
"status": "A",
"authorized_official_last_name": "METZ",
"authorized_official_first_name": "KEITH",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "248-223-9925",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "261QA1903X",
"taxonomy_group": "",
"desc": "Clinic/Center, Ambulatory Surgical",
"state": "MI",
"license": "261QA1903X",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS SECONDARY",
"identifier": "490F328640",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCARE",
"identifier": "17228",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS PRIMARY",
"identifier": "40332",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
- Great Lakes Home Care Agency LLC
- Great Lakes Pain and Injury Center
- Great Lakes Physicians of Southfield,PLLC
- Great Lakes Research Institute LLC
- Great Lakes Surgical Center Anesthesia, PLC
- Great Lakes Surgical Center, LLC
- Greater Detroit Culinary Services
- Greater Detroit Transportation
- Greater Health Center PLC
- Greater Health Center PLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.