Promedica Monroe Cardiology, PLLC

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

Legal business name

PROMEDICA MONROE CARDIOLOGY, PLLC

Doing business as

ProMedica Cardiology of Monroe

Practice address

730 N Macomb St
Suite 429
Monroe, MI 48162-2900

Phone

(734) 242-7060

Fax

(734) 241-7580

NPI assigned

Jan 21, 2011

Last updated

Oct 4, 2023By 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

Tanya Wines

Title

Director, System Credentialing

Phone

(567) 585-0422

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• ProMedica Cardiology of Monroe Doing business as

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

Practitioners 7

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.

• Jatin D Amin, M.D.

  • Cardiovascular Disease Physician
  • Monroe, MI
  • NPI 1710987060
  Medicare reassignment
• Ehsen Abdul-Kabir, MD

  • Internal Medicine Physician
  • Monroe, MI
  • NPI 1497325625
  NPD (past)
• Abdul Kabir, MD

  • Internal Medicine Physician
  • Monroe, MI
  • NPI 1477529154
  NPD (past)
• Michelle L Plumb, PA-C

  • Physician Assistant
  • Dearborn, MI
  • NPI 1982699872
  NPD (past)
• Kristi Ann Simmons, ATC, MS PA-C

  • Physician Assistant
  • Monroe, MI
  • NPI 1548287246
  NPD (past)
• Nicole Giudici, PA-C

  • Physician Assistant
  • Toledo, OH
  • NPI 1861725434
  NPD (past)
• Sandra K Oetting, NP-C

  • Nurse Practitioner
  • Perrysburg, OH
  • NPI 1992034458
  NPD (past)

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

{
    "created_epoch": "1295568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1659676708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MADISON AVE",
            "address_2": "MSC-S38805",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "43604",
            "telephone_number": "844-373-0871",
            "fax_number": "419-885-3921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 N MACOMB ST",
            "address_2": "SUITE 429",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481622900",
            "telephone_number": "734-242-7060",
            "fax_number": "734-241-7580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMEDICA MONROE CARDIOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-21",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "WINES",
        "authorized_official_first_name": "TANYA",
        "authorized_official_title_or_position": "DIRECTOR, SYSTEM CREDENTIALING",
        "authorized_official_telephone_number": "567-585-0422"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3126683",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProMedica Cardiology of Monroe",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ProMedica Cardiology of Monroe",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Danevin Putrus, DDS

• Cardiovascular Disease Physician in Monroe, MI
• Providers in Monroe, MI by specialty
• Cardiovascular Disease Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; 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.