St Clair Orthopaedics and Sports Medicine PC
Organization Active NPI Orthopaedic Surgery Physician · Saint Clair Shores, MI
NPI 1720041288 · NPPES record last updated Sep 23, 2024
Key facts
- NPI
- 1720041288
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- Legal business name
- ST CLAIR ORTHOPAEDICS AND SPORTS MEDICINE PC
- Practice address
- 23829 Little Mack Ave Ste 100
Saint Clair Shores, MI 48080-1186 - Phone
- (586) 773-1300
- NPI assigned
- Apr 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Christopher L Lee, MD
- Title
- President
- Phone
- (586) 416-1300
Other NPIs with the same Medicare PAC ID 1
Practitioners 30
-
Mark Andrew Bergin, M.D.
-
Anthony Paul Brunetti, PA-C
-
Damon O Collier, P.T.
-
James J Dietz, MD
-
Jean A Edmondson, NP
-
Anthony Fazi, NP
-
Catherine Kerr, OT
-
Linda McParlan, NP
-
Amber Myers, AGACNP-BC
-
Richard T Perry, MD
-
Courtney Sauter, OTRL
-
Vikas Suri, RPT
-
Karine Yu, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040805000566 | MI | Part B Supplier - Clinic/Group Practice | 4486625027 |
Receives reassigned benefits from 30 practitioners Practice locations: Macomb, MI; Saint Clair Shores, MI |
| O20100930006500 | MI | DME Supplier - Physician - Orthopedic/Orthopedic Surgery | 4486625027 | Practice locations: Macomb, MI |
National Provider Directory
Locations
22151 Moross Rd
Ste 212
Grosse Pointe, MI 48236
Phone (313) 343-7849
45441 Heydenreich Rd
Macomb, MI 48044
Phone (586) 226-8600
45555 Heydenreich Rd
Ste B
Macomb, MI 48044
22701 Hall Rd
Ste 200
Macomb, MI 48042
23829 Little Mack Ave
Saint Clair Shores, MI 48080
Phone (586) 412-8757
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician |
207X00000X | MI | Yes |
Addresses
Primary practice location
23829 Little Mack Ave Ste 100
Saint Clair Shores, MI 48080-1186
Mailing address
22701 Hall Rd Ste 100
Macomb, MI 48042-5270
Phone (586) 416-4265
Other practice location 1
22701 Hall Rd Ste 100
Macomb, MI 48042-5270
Phone (586) 416-4265
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0403130001 | Other | MI | MEDICARE SUPPLIER |
| 0E02122 | Other | MI | BLUE CROSS |
Other providers in Saint Clair Shores, MI
- Sydney Allyn Spatafore
- Jalyn Spencer-Harris
- Taylor Sheridan Spencer
- Chelsea June Sroufe
- St Clair Adult Medicine Specialists PC
- St Clair Pharmacy LLC
- St Clair Shore Pharmacy Mi LLC
- St Clair Shores Hearing Center
- St Clair Shores Mi Ophthalmology ASC LLC
- St Clair Shores Obstetrics and Gynecolgy, PLC
All providers in Saint Clair Shores, MI · Orthopaedic Surgery Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.