Individual provider Active NPI

Scott William Eathorne, MD

  • Family Medicine Physician
  • Farmington Hills, MI
National Provider Identifier
1760480974
Registry record updated Jan 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301056302 Issued in MI
Practice address
30055 Northwestern Hwy
#30
Farmington Hills, MI 48334-3230
Phone
(248) 865-4030
Fax
(248) 426-7335
NPI assigned
Jul 12, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X 4301055302 MI
Family Medicine Physician 207Q00000X 4301056302 MI Primary

Addresses

Primary practice location

30055 Northwestern Hwy
#30
Farmington Hills, MI 48334-3230

Mailing address

15990 W 9 Mile Rd
Southfield, MI 48075-4826
Phone (248) 849-4226

Other identifiers 1

IdentifierTypeStateIssuer
297537810MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100118000175 MI Practitioner - Family PracticePractitioner - Sports Medicine 6204746126 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Wayne State University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

22250 Providence Dr
FL 5
Southfield, MI 48075-4825
Phone (248) 849-3441

26750 Providence Pkwy
Novi, MI 48374-1211
Phone (248) 465-4782

26750 Providence Pkwy
Suite 210
Novi, MI 48374-1212
Phone (248) 465-4782

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301056302MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health Providence Hospital CurrentSince Jul 1, 1985 Accepting new patients
Henry Ford Health Providence Hospital CurrentSince Jul 1, 1985 Accepting new patients
Henry Ford Health Providence Hospital Current Accepting new patients
Henry Ford Health Providence Hospital Past Accepting new patients
Integrowth Orthopedic Specialists, PC Past Accepting new patients
University Neurosurgical Associates, PC Past Accepting new patients

Locations

30055 Northwestern Hwy
Ste 30
Farmington Hills, MI 48334
Phone (248) 253-8208

30055 Northwestern Hwy
#30
Farmington Hills, MI 48334
Phone (248) 865-4030

26750 Providence Pkwy
Ste 210
Novi, MI 48374
Phone (248) 465-4782

47601 Grand River Ave
Novi, MI 48374
Phone (248) 465-4100

47601 Grand River Ave
Ste A120
Novi, MI 48374
Phone (248) 465-5475

22250 Providence Dr
Ste 301
Southfield, MI 48075

15990 W 9 Mile Rd
Southfield, MI 48075
Phone (248) 849-5692

22250 Providence Dr
Fl 5
Southfield, MI 48075
Phone (248) 849-3441

28000 Dequindre Rd
Warren, MI 48092
Phone (586) 743-0944

Interoperability endpoints

  • Direct secure messaging: seathorne1125918@direct.hfhs.org

Organizations & group practices 6

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

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516838400000",
    "number": "1760480974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15990 W 9 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754826",
            "telephone_number": "248-849-4226",
            "fax_number": "248-849-4240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30055 NORTHWESTERN HWY",
            "address_2": "#30",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483343230",
            "telephone_number": "248-865-4030",
            "fax_number": "248-426-7335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EATHORNE",
        "first_name": "SCOTT",
        "middle_name": "WILLIAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-12",
        "last_updated": "2018-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MI",
            "license": "4301055302",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301056302",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "297537810",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington Hills, MI

Sources for this page

Verify at the official NPI Registry.