NPIMap

Organization Active NPI

St Clair Pulmonary & Critical Care P C

  • Pulmonary Disease Physician
  • Port Huron, MI
National Provider Identifier
1710909478
Registry record updated Dec 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
ST CLAIR PULMONARY & CRITICAL CARE P C
Practice address
2615 Electric Ave
Port Huron, MI 48060-6575
Phone
(810) 990-8222
Fax
(810) 937-5592
NPI assigned
Jul 24, 2006
Last updated
Dec 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2020

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

Authorized official

Name
Podduturu Sridhar Reddy, MD, MPHNPI 1003816331
Title
President
Phone
(810) 990-8222

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
Pulmonary Disease PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RP1001X Primary

Addresses

Primary practice location

2615 Electric Ave
Port Huron, MI 48060-6575

Mailing address

2615 Electric Ave
Port Huron, MI 48060-6575
Phone (810) 990-8222

Other practice location 1

1210 10th Ave
Port Huron, MI 48060-3406
Phone (810) 984-8470

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070214000204 MI Part B Supplier - Clinic/Group Practice 5395747786 Receives reassigned benefits from 2 practitioners
Practice locations: Harbor Beach, MI; Port Huron, MI

National Provider Directory

National Provider Directory

Locations

2615 Electric Ave
Port Huron, MI 48060
Phone (810) 984-8470

640 N 3rd St
Saint Clair, MI 48079
Phone (810) 984-8470

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/a2aabeb9-840e-4290-b28b-f0bb3ed955f9/

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609200000000",
    "number": "1710909478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2615 ELECTRIC AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480606575",
            "telephone_number": "810-990-8222",
            "fax_number": "810-937-5592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2615 ELECTRIC AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480606575",
            "telephone_number": "810-990-8222",
            "fax_number": "810-937-5592"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1210 10th Ave",
            "address_purpose": "LOCATION",
            "city": "Port Huron",
            "state": "MI",
            "postal_code": "480603406",
            "country_code": "US",
            "telephone_number": "810-984-8470",
            "fax_number": "810-984-3919",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST CLAIR PULMONARY & CRITICAL CARE P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-24",
        "last_updated": "2020-12-29",
        "certification_date": "2020-12-29",
        "status": "A",
        "authorized_official_last_name": "REDDY",
        "authorized_official_first_name": "PODDUTURU",
        "authorized_official_middle_name": "SRIDHAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "810-990-8222",
        "authorized_official_credential": "MD, MPH"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Huron, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.