Providence Ventures, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PROVIDENCE VENTURES, LLC

Doing business as

Bone and Joint Surgery Center of Novi

Practice address

26750 Providence Pkwy Ste 100
Novi, MI 48374-1211

Phone

(248) 662-1500

Fax

(248) 662-1501

NPI assigned

Jun 10, 2007

Last updated

Dec 19, 2019By 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

Marc A. Borovoy, DPM

Title

Governing Board President/Chairman

Phone

(248) 388-5842

Specialties & licenses 1

Addresses

Other names 1

• Bone and Joint Surgery Center of Novi Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Listed as

Bone and Joint Surgery Center of NoviCCN 23C0001102

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Henry Ford Health Providence Hospital

  dba Henry Ford Providence Hospital

  • Internal Medicine Physician
  • Southfield, MI
  • NPI 1922063213

  Member Of

  NPD member

Locations

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.

• Sean Francis Bak, MD

  • Orthopaedic Surgery Physician
  • Dearborn, MI
  • NPI 1386746675
  NPD (past)
• Nora Bass, RN, NP

  • Registered Nurse
  • Southfield, MI
  • NPI 1285636134
  NPD (past)
• Laith Anastas Farjo, M.D.

  • Orthopaedic Surgery Physician
  • Brighton, MI
  • NPI 1043279235
  NPD (past)
• Todd James Frush, MD

  • Orthopaedic Surgery Physician
  • Novi, MI
  • NPI 1427264910
  NPD (past)

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

{
    "created_epoch": "1181433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576713600000",
    "number": "1659574283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26750 PROVIDENCE PKWY STE 100",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483741211",
            "telephone_number": "248-662-1500",
            "fax_number": "248-662-1501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26750 PROVIDENCE PKWY STE 100",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483741211",
            "telephone_number": "248-662-1500",
            "fax_number": "248-662-1501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE VENTURES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-10",
        "last_updated": "2019-12-19",
        "certification_date": "2019-12-19",
        "status": "A",
        "authorized_official_last_name": "BOROVOY",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "GOVERNING BOARD PRESIDENT/CHAIRMAN",
        "authorized_official_telephone_number": "248-388-5842",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bone and Joint Surgery Center of Novi",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bone and Joint Surgery Center of Novi",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tracy Shmar Prosser, CNA
• Denise Patricia Provencher, PA-C
• Providence Hospital
• Providence Park Anesthesia Associates, PC
• Providence Park Internal Medicine PC
• Provident Dentistry
• Provident Sleep Solutions PLLC
• Tameka Pryor
• Tamarah Przybyla
• Jennifer Kaye Publow

• Ambulatory Surgical Clinic/Center in Novi, MI
• Providers in Novi, MI by specialty
• Ambulatory Surgical Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2019; 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.