NPIMap

Organization Active NPI

Ascension Providence Hospital

Doing business as TeleMedicine/Virtual Clinic

  • Internal Medicine Physician
  • Southfield, MI
National Provider Identifier
1730575085
Registry record updated Jun 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301056134 Issued in MI
Legal business name
ASCENSION PROVIDENCE HOSPITAL
Doing business as
TeleMedicine/Virtual Clinic
Practice address
16001 W 9 Mile Rd
Southfield, MI 48075-4818
Phone
(248) 849-2561
Fax
(248) 849-8313
NPI assigned
Apr 14, 2015
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
Supervisor, Enrollment
Phone
(248) 680-8121

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X 4301059442 MI
Internal Medicine Physician 207R00000X 4301056134 MI Primary
Interventional Cardiology Physician 207RI0011X 4301058284 MI
Pulmonary Disease Physician 207RP1001X 4301067318 MI
Neurology Physician 2084N0400X 4301055579 MI

Addresses

Primary practice location

16001 W 9 Mile Rd
Southfield, MI 48075-4818

Mailing address

28000 Dequindre Rd
Warren, MI 48092-2468
Phone (248) 680-8000

Other names 1

  • TeleMedicine/Virtual Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ascension Hospital32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Locations

43800 Garfield Rd
#104
Clinton Twp, MI 48038

NPI Registry JSON

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

{
    "created_epoch": "1428969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656374400000",
    "number": "1730575085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28000 DEQUINDRE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480922468",
            "telephone_number": "248-680-8000",
            "fax_number": "248-292-3852"
        },
        {
            "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": "248-849-2561",
            "fax_number": "248-849-8313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASCENSION PROVIDENCE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-14",
        "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": "SUPERVISOR, ENROLLMENT",
        "authorized_official_telephone_number": "248-680-8121"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "MI",
            "license": "4301059442",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301056134",
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MI",
            "license": "4301058284",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MI",
            "license": "4301067318",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301055579",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TeleMedicine/Virtual Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "TeleMedicine/Virtual Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.