NPIMap

Organization Active NPI

East Side Medical Services P C

  • Specialist
  • Saint Clair Shores, MI
National Provider Identifier
1629384144
Registry record updated Jan 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
4301031532 Issued in MI
Legal business name
EAST SIDE MEDICAL SERVICES P C
Practice address
22790 Harper Ave
Suite a
Saint Clair Shores, MI 48080-1831
Phone
(586) 445-3070
Fax
(586) 445-3072
NPI assigned
Aug 21, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2011

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

Authorized official

Name
Dr. Mohd S Jafri, M.D.
Title
Doctor
Phone
(586) 445-3070

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 4301031532 MI Primary

Addresses

Primary practice location

22790 Harper Ave
Suite a
Saint Clair Shores, MI 48080-1831

Mailing address

22790 Harper Ave
Suite a
Saint Clair Shores, MI 48080-1831
Phone (586) 445-3070

Other identifiers 1

IdentifierTypeStateIssuer
1285498MedicaidMI

Other names 1

  • EDGEWOOD CLINIC Other name

National Provider Directory

National Provider Directory

Locations

22790 Harper Ave
Ste A
St Clr Shores, MI 48080
Phone (586) 445-3070

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1282348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294185600000",
    "number": "1629384144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22790 HARPER AVE",
            "address_2": "SUITE A",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801831",
            "telephone_number": "586-445-3070",
            "fax_number": "586-445-3072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22790 HARPER AVE",
            "address_2": "SUITE A",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801831",
            "telephone_number": "586-445-3070",
            "fax_number": "586-445-3072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST SIDE MEDICAL SERVICES P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-21",
        "last_updated": "2011-01-05",
        "status": "A",
        "authorized_official_last_name": "JAFRI",
        "authorized_official_first_name": "MOHD",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "586-445-3070",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "MI",
            "license": "4301031532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285498",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EDGEWOOD CLINIC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2011; 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.