NPIMap

Organization Active NPI

Great Lakes Medicine, PLC

  • Hospitalist Physician
  • Shelby Township, MI
National Provider Identifier
1740210517
Registry record updated Nov 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
208M00000X Issued in MI
Legal business name
GREAT LAKES MEDICINE, PLC
Practice address
50505 Schoenherr Rd
Ste 340
Shelby Township, MI 48315-3140
Phone
(586) 731-8400
Fax
(586) 731-8406
NPI assigned
Jul 4, 2006
Last updated
Nov 5, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2012

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

Authorized official

Name
Dr. Prashant S Patel, MDNPI 1689668543
Title
Partner
Phone
(586) 731-8400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 207R00000X MI
Hospitalist Physician 208M00000X 208M00000X MI Primary

Addresses

Primary practice location

50505 Schoenherr Rd
Ste 340
Shelby Township, MI 48315-3140

Mailing address

1746 Momentum PL
Chicago, IL 60689-5317
Phone (586) 731-8400

Other identifiers 2

IdentifierTypeStateIssuer
DE1755OtherMIRR MEDICARE
0E03034OtherMIBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051122000265 MI Part B Supplier - Clinic/Group Practice 4880613637 Receives reassigned benefits from 58 practitioners
Practice locations: Shelby Township, MI

National Provider Directory

National Provider Directory

Locations

1746 Momentum Pl
Chicago, IL 60689

18720 Mack Ave
Ste 210
Grosse Pointe Farms, MI 48236
Phone (313) 343-5661

18720 Mack Ave
Ste 230
Grosse Pointe Farms, MI 48236
Phone (313) 343-5661

28300 Harper Ave
St Clr Shores, MI 48081
Phone (586) 776-2498

Practitioners & affiliated clinicians

Practitioners 72

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 72

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352073600000",
    "number": "1740210517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1746 MOMENTUM PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606895317",
            "telephone_number": "586-731-8400",
            "fax_number": "586-731-8406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50505 SCHOENHERR RD",
            "address_2": "STE 340",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483153140",
            "telephone_number": "586-731-8400",
            "fax_number": "586-731-8406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES MEDICINE, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2012-11-05",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "PRASHANT",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "586-731-8400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "207R00000X",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MI",
            "license": "208M00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DE1755",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0E03034",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby Township, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2012; 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.