NPIMap

Organization Active NPI

Comprehensive Diabetic Supplies, LLC

  • Durable Medical Equipment & Medical Supplies
  • Warren, MI
National Provider Identifier
1730324146
Registry record updated Mar 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
COMPREHENSIVE DIABETIC SUPPLIES, LLC
Practice address
3200 E 12 Mile Rd Ste 205
Warren, MI 48092-5621
Phone
(586) 585-1540
Fax
(586) 585-1537
NPI assigned
Dec 15, 2008
Last updated
Mar 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2022

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

Authorized official

Name
Mr. John Dellavecchia
Title
Owner
Phone
(586) 585-1540

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X MI Primary

Addresses

Primary practice location

3200 E 12 Mile Rd Ste 205
Warren, MI 48092-5621

Mailing address

3200 E 12 Mile Rd Ste 205
Warren, MI 48092-5621
Phone (586) 585-1540

Other identifiers 1

IdentifierTypeStateIssuer
6253130001MedicaidMI

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address john@compdiabetic.com
Direct Messaging Address john@compdiabetic.com
Direct Messaging Address john@compdiabetic.com

National Provider Directory

National Provider Directory

Locations

21541 Harper Ave
St Clr Shores, MI 48080
Phone (586) 585-1540

21545 Harper Ave
St Clr Shores, MI 48080
Phone (586) 585-1540

Interoperability endpoints

  • Direct secure messaging: john@compdiabetic.com

NPI Registry JSON

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

{
    "created_epoch": "1229299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646611200000",
    "number": "1730324146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 E 12 MILE RD STE 205",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480925621",
            "telephone_number": "586-585-1540",
            "fax_number": "586-585-1537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 E 12 MILE RD STE 205",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480925621",
            "telephone_number": "586-585-1540",
            "fax_number": "586-585-1537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE DIABETIC SUPPLIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-15",
        "last_updated": "2022-03-07",
        "certification_date": "2022-02-09",
        "status": "A",
        "authorized_official_last_name": "DELLAVECCHIA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "586-585-1540",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6253130001",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "john@compdiabetic.com",
            "affiliation": "N",
            "address_1": "3200 E 12 Mile Rd Ste 205",
            "city": "Warren",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480925621",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "john@compdiabetic.com",
            "affiliation": "N",
            "address_1": "3200 E 12 Mile Rd Ste 205",
            "city": "Warren",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480925621",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "john@compdiabetic.com",
            "affiliation": "N",
            "address_1": "3200 E 12 Mile Rd Ste 205",
            "city": "Warren",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480925621",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.