NPIMap

Individual provider Active NPI

Thomas J Ridella, MD

  • Family Medicine Physician
  • Canton, MI
National Provider Identifier
1730641523
Registry record updated Sep 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
74800 Issued in WI
Practice address
2050 N Haggerty Rd Ste 220
Canton, MI 48187-3796
Phone
(734) 446-9757
Fax
(734) 446-9750
NPI assigned
Apr 2, 2019
Last updated
Sep 12, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 74800 WI Primary

Addresses

Primary practice location

2050 N Haggerty Rd Ste 220
Canton, MI 48187-3796

Mailing address

26901 Beaumont Blvd # 3D
Southfield, MI 48033-3849
Phone (947) 522-1952

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tridella4644357@direct.beaumont.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221011001486 MI Practitioner - Family Practice 4486988540 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Human Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oakwood Ambulatory LLCGroup PAC ID 1850282914, 271 clinicians

Practice addresses (Care Compare)

201 3Rd St
Suite 200
Belleville, MI 48111-2605
Phone (734) 697-9065

2050 N Haggerty Rd
Canton, MI 48187-3796

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
74800WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oakwood Ambulatory LLC Single Specialty CurrentSince Sep 30, 2022 Accepting new patients
Oakwood Ambulatory, LLC Single Specialty CurrentSince Sep 30, 2022 Accepting new patients

Locations

201 3rd St
Ste 200
Belleville, MI 48111
Phone (734) 697-9065

2050 N Haggerty Rd
Ste 200
Canton, MI 48187
Phone (313) 438-7880

2050 N Haggerty Rd
Ste 220
Canton, MI 48187
Phone (734) 446-9757

26901 Beaumont Blvd
#3D
Southfield, MI 48033

Interoperability endpoints

  • Direct secure messaging: tridella1252908@epic00.shdirect.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1554163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694476800000",
    "number": "1730641523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD # 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849",
            "telephone_number": "947-522-1952",
            "fax_number": "947-522-0307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2050 N HAGGERTY RD STE 220",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481873796",
            "telephone_number": "734-446-9757",
            "fax_number": "734-446-9750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDELLA",
        "first_name": "THOMAS",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-02",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "74800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tridella4644357@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "2050 N Haggerty Rd Ste 220",
            "city": "Canton",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481873796",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Canton, MI

Sources for this page

Verify at the official NPI Registry.