NPIMap

Individual provider Active NPI

Shirley C Tom, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Dearborn, MI
National Provider Identifier
1639483084
Registry record updated Sep 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
4301097230 Issued in MI
Practice address
17000 Hubbard Dr
Dearborn, MI 48126-4258
Phone
(313) 593-7000
NPI assigned
Jul 27, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301097230 MI
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 4301097230 MI Primary

Addresses

Primary practice location

17000 Hubbard Dr
Dearborn, MI 48126-4258

Mailing address

17000 Hubbard Dr
Dearborn, MI 48126-4258
Phone (313) 593-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131024001064 MI Practitioner - Geriatric MedicinePractitioner - Internal Medicine 5294960423 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Geriatric MedicineAlso: Internal Medicine
Education
Michigan State University College of Human Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Oakwood Ambulatory LLCGroup PAC ID 1850282914, 271 clinicians
Dearborn Physical Therapy LTDGroup PAC ID 2668383910, shared by 2 NPIs, 97 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

17000 Hubbard Dr
Dearborn, MI 48126-4258
Phone (313) 982-4351

201 3Rd St
Suite 200
Belleville, MI 48111-2605
Phone (734) 697-9065

23852 Michigan Ave
Dearborn, MI 48124-1829

2600 Compass Rd
Glenview, IL 60026-8001

4700 Schaefer Rd
Dearborn, MI 48126-3743

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301097230MIMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oakwood Ambulatory, LLC CurrentSince Sep 1, 2016 Accepting new patients
Oakwood Ambulatory LLC Internal Medicine CurrentSince Sep 1, 2016 Accepting new patients

Locations

201 3rd St
Ste 200
Belleville, MI 48111
Phone (734) 697-9065

4700 Schaefer Rd
Ste 240
Dearborn, MI 48126
Phone (313) 827-0480

17000 Hubbard Dr
Dearborn, MI 48126
Phone (313) 271-3802

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1280188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473984000000",
    "number": "1639483084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17000 HUBBARD DR",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481264258",
            "telephone_number": "313-593-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17000 HUBBARD DR",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481264258",
            "telephone_number": "313-593-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOM",
        "first_name": "SHIRLEY",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-27",
        "last_updated": "2016-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301097230",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MI",
            "license": "4301097230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.