Southgate Medical Group, PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SOUTHGATE MEDICAL GROUP, PLLC

Doing business as

Schafer Farms Medical Group, PLLC

Practice address

3 Heritage Center
Suite 1
Southgate, MI 48195

Phone

(734) 283-3222

Fax

(734) 283-4006

NPI assigned

Jan 3, 2007

Last updated

Mar 30, 2009By 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

Michael Jamil Neshewat, M.D.NPI 1174553770

Title

President

Phone

(734) 283-3222

Specialties & licenses 2

Addresses

Other names 1

• Schafer Farms Medical Group, PLLC Doing business as

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

Practitioners 4

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.

• Michael Neshewat, M.D.

  • Internal Medicine Physician
  • Southgate, MI
  • NPI 1174553770
  Medicare reassignment Care Compare group NPD Authorized official
• Kelcie Ann Waack, FNP

  • Internal Medicine Physician
  • Southgate, MI
  • NPI 1730762246
  Medicare reassignment Care Compare group NPD
• Ahmad Moayad Yasin, M.D.

  • Internal Medicine Physician
  • Ypsilanti, MI
  • NPI 1598007510
  Medicare reassignment NPD
• Jovan Vasilija Popovich

  • Physician Assistant
  • Peabody, MA
  • NPI 1396384707

  MI

  Medicare reassignment

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238371200000",
    "number": "1619034071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 HERITAGE CENTER",
            "address_2": "SUITE 1",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "48195",
            "telephone_number": "734-283-3222",
            "fax_number": "734-283-4006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 HERITAGE CENTER",
            "address_2": "SUITE 1",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "48195",
            "telephone_number": "734-283-3222",
            "fax_number": "734-283-4006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHGATE MEDICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2009-03-30",
        "status": "A",
        "authorized_official_last_name": "NESHEWAT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JAMIL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "734-283-3222",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Schafer Farms Medical Group, PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Internal Medicine Physician in Southgate, MI
• Providers in Southgate, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2009; 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.