Organization Active NPI

Northeast Surgical Group PC

  • Surgery Physician
  • Macomb, MI
National Provider Identifier
1700984200
Registry record updated Jan 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
NORTHEAST SURGICAL GROUP PC
Practice address
17375 Hall Rd
Macomb, MI 48044-4060
Phone
(586) 228-0550
Fax
(586) 228-8830
NPI assigned
Sep 20, 2006
Last updated
Jan 15, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2015

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

Authorized official

Name
Dr. James Henry McQuiston, DONPI 1053302091
Title
Managing Partner
Phone
(586) 228-0550

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MI Primary

Addresses

Primary practice location

17375 Hall Rd
Macomb, MI 48044-4060

Mailing address

17375 Hall Rd
Macomb, MI 48044-4060
Phone (586) 228-0550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040504000627 MI Part B Supplier - Clinic/Group Practice 1355339870 Receives reassigned benefits from 3 practitioners
Practice locations: Mount Clemens, MI; Macomb, MI

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0363909Northeast Surgical Group PC17375 Hall Road, Macomb Township, MI 48044Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421280000000",
    "number": "1700984200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17375 HALL RD",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480444060",
            "telephone_number": "586-228-0550",
            "fax_number": "586-228-8830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17375 HALL RD",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480444060",
            "telephone_number": "586-228-0550",
            "fax_number": "586-228-8830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST SURGICAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2015-01-15",
        "status": "A",
        "authorized_official_last_name": "MCQUISTON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "HENRY",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "586-228-0550",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macomb, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2015; 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.