NPIMap

Organization Active NPI

Summit Oral & Maxillofacial Surgery PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Warren, MI
National Provider Identifier
1811066129
Registry record updated Sep 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
SUMMIT ORAL & MAXILLOFACIAL SURGERY PC
Practice address
29427 Ryan Rd
Warren, MI 48092-2203
Phone
(586) 755-9340
Fax
(586) 755-9341
NPI assigned
Nov 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2009

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

Authorized official

Name
Ms. Jane M Windisch
Title
Billing Specialist
Phone
(586) 755-9340

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

29427 Ryan Rd
Warren, MI 48092-2203

Mailing address

29425 Ryan Rd
Warren, MI 48092-2203
Phone (586) 755-9340

Other identifiers 2

IdentifierTypeStateIssuer
970E076800OtherMIBC
0E07680OtherMIMEDICARE PTAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040915000948 MI Part B Supplier - Clinic/Group Practice 5991772287 Receives reassigned benefits from 8 practitioners
Practice locations: Clinton Township, MI; Grosse Pointe Woods, MI; Macomb, MI; New Baltimore, MI; Rochester Hills, MI; Warren, MI; Washington Township, MI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2128454Summit Oral & Maxillofacial Surgery29427 Ryan Road, Warren, MI 48092Certificate of waiverMar 29, 2027

National Provider Directory

National Provider Directory

Locations

15870 19 Mile Rd
Ste 150
Clinton Twp, MI 48038

20675 Mack Ave
Grosse Pointe Woods, MI 48236
Phone (313) 885-8344

29427 Ryan Rd
Warren, MI 48092
Phone (586) 755-9340

25900 Dequindre Rd
Warren, MI 48091
Phone 5867559340106

29425 Ryan Rd
Warren, MI 48092
Phone (586) 755-9340

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252886400000",
    "number": "1811066129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29425 RYAN RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480922203",
            "telephone_number": "586-755-9340",
            "fax_number": "586-755-9341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29427 RYAN RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480922203",
            "telephone_number": "586-755-9340",
            "fax_number": "586-755-9341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT ORAL & MAXILLOFACIAL SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2009-09-14",
        "status": "A",
        "authorized_official_last_name": "WINDISCH",
        "authorized_official_first_name": "JANE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BILLING SPECIALIST",
        "authorized_official_telephone_number": "586-755-9340",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC",
            "identifier": "970E076800",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "0E07680",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.