NPIMap

Organization Active NPI

McLaren Macomb

  • Family Medicine Physician
  • Shelby Township, MI
National Provider Identifier
1821040288
Registry record updated May 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MCLAREN MACOMB
Practice address
8180 26 Mile Rd.
Ste. 101
Shelby Township, MI 48316
Phone
(586) 677-3355
Fax
(586) 677-3352
NPI assigned
May 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2018

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

Authorized official

Name
Mr. Thomas M Brisse
Title
Ceo
Phone
(586) 493-8083

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

8180 26 Mile Rd.
Ste. 101
Shelby Township, MI 48316

Mailing address

8180 26 Mile Rd.
Ste. 101
Shelby Township, MI 48316-5129
Phone (586) 677-3355

Other identifiers 6

IdentifierTypeStateIssuer
4259188MedicaidMI
4414024MedicaidMI
4346739MedicaidMI
4463889MedicaidMI
4428146MedicaidMI
4282112MedicaidMI

National Provider Directory

National Provider Directory
Tax ID family
Georgetown OB GYN12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527033600000",
    "number": "1821040288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8180 26 MILE RD.",
            "address_2": "STE. 101",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483165129",
            "telephone_number": "586-677-3355",
            "fax_number": "586-677-3352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8180 26 MILE RD.",
            "address_2": "STE. 101",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "48316",
            "telephone_number": "586-677-3355",
            "fax_number": "586-677-3352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLAREN MACOMB",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2018-05-23",
        "status": "A",
        "authorized_official_last_name": "BRISSE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "586-493-8083",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4259188",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4414024",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4346739",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4463889",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4428146",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4282112",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby Township, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2018; 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.