Active NPI
Serguei Medvedev, M.D
- Internal Medicine Physician
- Pontiac, MI
National Provider Identifier
1609490705
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 4351046860
- Practice address
- 44405 Woodward Avenue
Medical Education-H23
Pontiac, MI 48341 - Phone
- (248) 858-3000
- NPI assigned
- Jun 4, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 4351046860 | MI | Primary |
Addresses
Primary practice location
44405 Woodward Avenue
Medical Education-H23
Pontiac, MI 48341
Mailing address
44405 Woodward Avenue
Medical Education-H23
Pontiac, MI 48341
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593648000000",
"number": "1609490705",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "44405 WOODWARD AVENUE",
"address_2": "MEDICAL EDUCATION-H23",
"city": "PONTIAC",
"state": "MI",
"postal_code": "48341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44405 WOODWARD AVENUE",
"address_2": "MEDICAL EDUCATION-H23",
"city": "PONTIAC",
"state": "MI",
"postal_code": "48341",
"telephone_number": "248-858-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDVEDEV",
"first_name": "SERGUEI",
"credential": "M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-06-04",
"last_updated": "2020-07-02",
"certification_date": "2020-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "4351046860",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pontiac, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.