Providence-Providence Park Hospital

Primary specialty

Registered NurseTaxonomy code 163W00000X

Legal business name

PROVIDENCE-PROVIDENCE PARK HOSPITAL

Practice address

16001 W 9 Mile Rd
Physician Billing Services
Southfield, MI 48075-4818

Phone

(248) 849-3000

Fax

(248) 849-2244

NPI assigned

Apr 20, 2006

Last updated

Aug 25, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer Johnson

Title

Director, Central Billing Office

Phone

(248) 680-8206

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• PH Nurse Practitioners/Providence Hospital and Medical Centers Inc Other name

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472083200000",
    "number": "1780649822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 LIVERNOIS RD",
            "address_2": "SUITE 500",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831215",
            "telephone_number": "248-680-8000",
            "fax_number": "248-680-8032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16001 W 9 MILE RD",
            "address_2": "PHYSICIAN BILLING SERVICES",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754818",
            "telephone_number": "248-849-3000",
            "fax_number": "248-849-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE-PROVIDENCE PARK HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2016-08-25",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "DIRECTOR, CENTRAL BILLING OFFICE",
        "authorized_official_telephone_number": "248-680-8206"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163WH1000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Hospice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163WM0102X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Maternal Newborn",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI BLUE CROSS GROUP PIN #",
            "identifier": "500F319040",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PH Nurse Practitioners/Providence Hospital and Medical Centers Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Providence-Providence Park Hospital
• Providing Hearts Home Health Service
• Talia Onay Pruiett
• Alexis Pruitt
• Jamarr A Pruitt, CARDIO PHLEBOTOMIST
• Renee M Przeslawski, MPT

• Registered Nurse in Southfield, MI
• Providers in Southfield, MI by specialty
• Registered Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2016; 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.