Riverside OB GYN P C

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

RIVERSIDE OB GYN P C

Practice address

2275 W Jefferson Ave
Trenton, MI 48183-2114

Phone

(734) 675-7210

Fax

(734) 675-3023

NPI assigned

May 9, 2006

Last updated

Jun 26, 2012By 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

Dr. Ahmad I. Al-Jerdi, D.O.NPI 1023067063

Title

President

Phone

(734) 675-7210

Specialties & licenses 1

Addresses

Other identifiers 12

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

Practitioners 3

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.

• Ahmad I Al-Jerdi, D.O.

  • Obstetrics & Gynecology Physician
  • Trenton, MI
  • NPI 1023067063
  Medicare reassignment Authorized official
• Ashwin H Shah, MD

  • Urology Physician
  • Monroe, MI
  • NPI 1710983812
  NPD (past)
• Tammy Vo-Mota, PA-C

  • Medical Physician Assistant
  • Trenton, MI
  • NPI 1477947588
  NPD (past)

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340668800000",
    "number": "1699724559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2275 W JEFFERSON AVE",
            "city": "TRENTON",
            "state": "MI",
            "postal_code": "481832114",
            "telephone_number": "734-675-7210",
            "fax_number": "734-675-3023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2275 W JEFFERSON AVE",
            "city": "TRENTON",
            "state": "MI",
            "postal_code": "481832114",
            "telephone_number": "734-675-7210",
            "fax_number": "734-675-3023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE OB GYN P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2012-06-26",
        "status": "A",
        "authorized_official_last_name": "AL-JERDI",
        "authorized_official_first_name": "AHMAD",
        "authorized_official_middle_name": "I.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "734-675-7210",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "160003353",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "160055739",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2966851",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "7139017",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1540358-11",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "160055737",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "160H210680",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4106545-11",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4165045-10",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "160059461",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4471183-11",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "6676861",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Emma Marie Roberts
• Lauren Roberts

• Obstetrics & Gynecology Physician in Trenton, MI
• Providers in Trenton, MI by specialty
• Obstetrics & Gynecology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2012; 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.