NPIMap

Organization Active NPI

St John Hospital and Medical Center

  • Family Medicine Physician
  • Saint Clair Shores, MI
National Provider Identifier
1780854174
Registry record updated Mar 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301088641 Issued in MI
Legal business name
ST JOHN HOSPITAL AND MEDICAL CENTER
Practice address
24911 Little Mack Ave
Suite C
Saint Clair Shores, MI 48080-3200
Phone
(586) 447-9081
NPI assigned
Mar 3, 2008
Last updated
Mar 3, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2008

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

Authorized official

Name
Dr. Kenneth Bollin, M.D.NPI 1144212788
Title
Chief of the Department of FM
Phone
(586) 447-9081

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301088641 MI Primary

Addresses

Primary practice location

24911 Little Mack Ave
Suite C
Saint Clair Shores, MI 48080-3200

Mailing address

21441 Sloan Dr
Apt # 102 B
Harper Woods, MI 48225-2428

National Provider Directory

National Provider Directory
Tax ID family
St Johns Hospital74 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

24911 Little Mack Ave
Ste C
St Clr Shores, MI 48080
Phone (586) 777-2050

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": "1204502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204502400000",
    "number": "1780854174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21441 SLOAN DR",
            "address_2": "APT # 102 B",
            "city": "HARPER WOODS",
            "state": "MI",
            "postal_code": "482252428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24911 LITTLE MACK AVE",
            "address_2": "SUITE C",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480803200",
            "telephone_number": "586-447-9081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHN HOSPITAL AND MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-03",
        "last_updated": "2008-03-03",
        "status": "A",
        "authorized_official_last_name": "BOLLIN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "CHIEF OF THE DEPARTMENT OF FM",
        "authorized_official_telephone_number": "586-447-9081",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301088641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2008; 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.