NPIMap

Organization Active NPI

Ascension Providence Hospital

  • Orthopaedic Surgery Physician
  • Southfield, MI
National Provider Identifier
1730144791
Registry record updated Jun 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
ASCENSION PROVIDENCE HOSPITAL
Practice address
16001 W 9 Mile Rd
Southfield, MI 48075-4818
Phone
(248) 849-3000
Fax
(248) 849-2244
NPI assigned
Apr 20, 2006
Last updated
Jun 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2022

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

Authorized official

Name
Sarah Starkel
Title
Enrollment, Supervisor
Phone
(248) 680-8121

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X Primary

Addresses

Primary practice location

16001 W 9 Mile Rd
Southfield, MI 48075-4818

Mailing address

2800 Livernois Rd
Suite 500
Troy, MI 48083-1215
Phone (248) 680-8000

Other identifiers 1

IdentifierTypeStateIssuer
200F370810OtherMIMI BLUE CROSS PIN #

Other names 1

  • PH Orthopedics/Providence Hospital and Medical Centers Inc Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031103000326 MI Part B Supplier - Clinic/Group Practice 6103738703 Receives reassigned benefits from 466 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656374400000",
    "number": "1730144791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 LIVERNOIS RD",
            "address_2": "SUITE 500",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831215",
            "telephone_number": "248-680-8000",
            "fax_number": "248-680-8032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16001 W 9 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754818",
            "telephone_number": "248-849-3000",
            "fax_number": "248-849-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASCENSION PROVIDENCE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A",
        "authorized_official_last_name": "STARKEL",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "ENROLLMENT, SUPERVISOR",
        "authorized_official_telephone_number": "248-680-8121"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI BLUE CROSS PIN #",
            "identifier": "200F370810",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PH Orthopedics/Providence Hospital and Medical Centers Inc",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "PH Orthopedics/Providence Hospital and Medical Centers Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2022; 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.