NPIMap

Organization Active NPI

St John Detroit Macomb Hospital Corporation

  • Surgery Physician
  • Madison Heights, MI
National Provider Identifier
1750470589
Registry record updated Aug 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
ST JOHN DETROIT MACOMB HOSPITAL CORPORATION
Practice address
27483 Dequindre Rd
204
Madison Heights, MI 48071-3491
Phone
(248) 967-7326
Fax
(248) 967-7330
NPI assigned
Oct 12, 2006
Last updated
Aug 8, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2007

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

Authorized official

Name
Sandra Ellen Whitman
Title
Director PBS
Phone
(248) 746-3218

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X Primary

Addresses

Primary practice location

27483 Dequindre Rd
204
Madison Heights, MI 48071-3491

Mailing address

25925 Telegraph Rd
210
Southfield, MI 48034-2518
Phone (248) 746-3218

Other identifiers 1

IdentifierTypeStateIssuer
70-0H2015300OtherMIBLUE CROSS GROUP PIN

Other names 1

  • St John Weight Loss Center Other name

National Provider Directory

National Provider Directory
Tax ID family
St Joh Health System DM36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

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

View all 35

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186531200000",
    "number": "1750470589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25925 TELEGRAPH RD",
            "address_2": "210",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480342518",
            "telephone_number": "248-746-3218",
            "fax_number": "248-746-0369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27483 DEQUINDRE RD",
            "address_2": "204",
            "city": "MADISON HEIGHTS",
            "state": "MI",
            "postal_code": "480713491",
            "telephone_number": "248-967-7326",
            "fax_number": "248-967-7330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHN DETROIT MACOMB HOSPITAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-08-08",
        "status": "A",
        "authorized_official_last_name": "WHITMAN",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "DIRECTOR PBS",
        "authorized_official_telephone_number": "248-746-3218"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP PIN",
            "identifier": "70-0H2015300",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St John Weight Loss Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Madison Heights, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2007; 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.