Medpro Primary Care PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

MEDPRO PRIMARY CARE PLLC

Practice address

17901 Huron River Dr
New Boston, MI 48164-3200

Phone

(734) 315-7070

NPI assigned

Feb 3, 2020

Last updated

Feb 11, 2021By 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

Joshua Ruedisueli, PANPI 1326425851

Title

Owner

Phone

(734) 315-7070

Specialties & licenses 2

Addresses

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

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/21116/brand/1/csg/1/fhir/r4

Practitioners 11

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.

• Joshua Edward Ruedisueli, PA

  • Physician Assistant
  • Southfield, MI
  • NPI 1326425851
  Medicare reassignment Care Compare group Authorized official
• Samantha Evelyn Demarce

  • Family Nurse Practitioner
  • New Boston, MI
  • NPI 1447957816
  Medicare reassignment Care Compare group NPD
• Michael Jakubik

  • Acute Care Nurse Practitioner
  • Southfield, MI
  • NPI 1457753956
  Medicare reassignment Care Compare group NPD
• Daniel Kapadia, M.D.

  • Pulmonary Disease Physician
  • Rochester, MI
  • NPI 1093179681

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Chadius M Milton

  • Medical Physician Assistant
  • Detroit, MI
  • NPI 1124508122
  Medicare reassignment Care Compare group NPD
• Devyn Elisabeth Music

  • Medical Physician Assistant
  • Madison Heights, MI
  • NPI 1386442168
  Medicare reassignment Care Compare group NPD
• Ashleigh Alexandria Finazzo, PA

  • Medical Physician Assistant
  • Ferndale, MI
  • NPI 1912394966
  Medicare reassignment Care Compare group
• Natalie Jan Kase, PA-C

  • Physician Assistant
  • Davison, MI
  • NPI 1720746696
  Medicare reassignment Care Compare group
• Jaclyn Weber, PA

  • Physician Assistant
  • New Boston, MI
  • NPI 1992371702
  Medicare reassignment Care Compare group
• Matthew Alan Zaborowicz, MD

  • Family Medicine Physician
  • Flint, MI
  • NPI 1528596723
  Medicare reassignment
• Jeffrey Thewes, M.D.

  • Emergency Medicine Physician
  • Clarkston, MI
  • NPI 1649329418
  NPD (past)

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

{
    "created_epoch": "1580688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613001600000",
    "number": "1639700107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17901 HURON RIVER DR",
            "city": "NEW BOSTON",
            "state": "MI",
            "postal_code": "481643200",
            "telephone_number": "734-315-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17901 HURON RIVER DR",
            "city": "NEW BOSTON",
            "state": "MI",
            "postal_code": "481643200",
            "telephone_number": "734-315-7070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDPRO PRIMARY CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-03",
        "last_updated": "2021-02-11",
        "certification_date": "2021-02-11",
        "status": "A",
        "authorized_official_last_name": "RUEDISUELI",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-315-7070",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Fay Johnson, LMT
• Ashlyn Rochelle Kelly, DPT, PT
• Cheryl Lamar
• Makk Group LLC
• Toms P Mathew, M.D.
• Dario Merlos, DDS
• Amanda Mosed
• MTT FNP LLC
• New Beginnings Counseling Center LLC
• New Boston Dental Clinic PC

• Internal Medicine Physician in New Boston, MI
• Providers in New Boston, 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 Feb 11, 2021; 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.