NPIMap

Organization Active NPI

Silver Pine Medical Group PLC

  • Family Medicine Physician
  • Sterling Heights, MI
National Provider Identifier
1639105695
Registry record updated Dec 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SILVER PINE MEDICAL GROUP PLC
Practice address
43455 Schoenherr
Suite 2
Sterling Heights, MI 48313
Phone
(586) 726-4823
Fax
(586) 726-8365
NPI assigned
Jun 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2008

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

Authorized official

Name
Dr. Theodore L Tangalos, M.D.NPI 1760466585
Title
President
Phone
(586) 726-4823

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)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

43455 Schoenherr
Suite 2
Sterling Heights, MI 48313

Mailing address

43455 Schoenherr
Suite 2
Sterling Heights, MI 48313
Phone (586) 726-4823

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040603000737 MI Part B Supplier - Clinic/Group Practice 8325020332 Receives reassigned benefits from 72 practitioners
Practice locations: Sterling HTS, MI; Sterling Heights, MI; Shelby Township, MI; Macomb, MI; Lenox, MI; Chesterfield, MI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0954433Silver Pine Medical Group43455 Schoenherr Rd, Suite 19, Sterling Heights, MI 48313ComplianceJul 24, 2027

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

31225 23 Mile Rd
Chesterfield, MI 48047
Phone (586) 598-2900

36555 26 Mile Rd
Ste 2500
Lenox, MI 48048

15959 Hall Rd
Ste 110
Macomb, MI 48044

13860 Canal Rd
Ste 300
Sterling Heights, MI 48313

43455 Schoenherr Rd
Sterling Hts, MI 48313
Phone (248) 373-7600

Practitioners & affiliated clinicians

Practitioners 74

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

View all 74

NPI Registry JSON

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228262400000",
    "number": "1639105695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43455 SCHOENHERR",
            "address_2": "SUITE 2",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "48313",
            "telephone_number": "586-726-4823",
            "fax_number": "586-726-8365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43455 SCHOENHERR",
            "address_2": "SUITE 2",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "48313",
            "telephone_number": "586-726-4823",
            "fax_number": "586-726-8365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SILVER PINE MEDICAL GROUP PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-23",
        "last_updated": "2008-12-03",
        "status": "A",
        "authorized_official_last_name": "TANGALOS",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-726-4823",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sterling Heights, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 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.

Verify at the official NPI Registry.