NPIMap

Organization Active NPI

Botsford General Hospital

Doing business as Northside Medical Center

  • Family Medicine Physician
  • Detroit, MI
National Provider Identifier
1780819664
Registry record updated Feb 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BOTSFORD GENERAL HOSPITAL
Doing business as
Northside Medical Center
Practice address
14001 Greenfield
Detroit, MI 48227-2101
Phone
(313) 273-1200
Fax
(313) 273-8130
NPI assigned
May 21, 2009
Last updated
Feb 11, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
BOTSFORD GENERAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 11, 2019

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

Authorized official

Name
Lesley Willbrandt
Title
Director Shared Services
Phone
(947) 522-1911

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

14001 Greenfield
Detroit, MI 48227-2101

Mailing address

26901 Beaumont Boulevard
Ste. 3D
Southfield, MI 48033-3849
Phone (947) 522-1857

Other names 1

  • Northside Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031112000174 MI Part B Supplier - Clinic/Group Practice 2668385238 Receives reassigned benefits from 10 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Livonia, MI; Farmington Hills, MI; Detroit, MI

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Botsford General HSP20 organizations share this tax ID, including this one
Part of
Botsford General HSP

Other organizations with this tax ID 19

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

View all 19

Locations

14001 Greenfield Rd
Detroit, MI 48227
Phone (313) 273-1200

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": "1242864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549843200000",
    "number": "1780819664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BOULEVARD",
            "address_2": "STE. 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849",
            "telephone_number": "947-522-1857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14001 GREENFIELD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482272101",
            "telephone_number": "313-273-1200",
            "fax_number": "313-273-8130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOTSFORD GENERAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOTSFORD GENERAL HOSPITAL",
        "enumeration_date": "2009-05-21",
        "last_updated": "2019-02-11",
        "status": "A",
        "authorized_official_last_name": "WILLBRANDT",
        "authorized_official_first_name": "LESLEY",
        "authorized_official_title_or_position": "DIRECTOR SHARED SERVICES",
        "authorized_official_telephone_number": "947-522-1911"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northside Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northside Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2019; 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.