NPIMap

Organization Active NPI

McLaren Macomb

Doing business as Pediatric Specialty Group

  • Pediatric Neurodevelopmental Disabilities Physician
  • Clinton Township, MI
National Provider Identifier
1821049990
Registry record updated May 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Neurodevelopmental Disabilities PhysicianTaxonomy code 2080P0008X
Legal business name
MCLAREN MACOMB
Doing business as
Pediatric Specialty Group
Practice address
43900 Garfield Rd
Ste. 201
Clinton Township, MI 48038
Phone
(586) 412-5110
Fax
(586) 412-5116
NPI assigned
May 13, 2006
Last updated
May 23, 2018By the provider in NPPES
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
Mrs. Thomas M Brisse
Title
Ceo
Phone
(586) 493-8083

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Neurodevelopmental Disabilities PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0008X Primary
Pediatric Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0202X

Addresses

Primary practice location

43900 Garfield Rd
Ste. 201
Clinton Township, MI 48038

Mailing address

43900 Garfield Rd
Ste. 201
Clinton Township, MI 48038-1128
Phone (586) 412-5110

Other identifiers 4

IdentifierTypeStateIssuer
4168314MedicaidMI
3518937MedicaidMI
3298780MedicaidMI
3298762MedicaidMI

Other names 1

  • Pediatric Specialty Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
James Giliberto Jr12 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": "1147478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527033600000",
    "number": "1821049990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43900 GARFIELD RD",
            "address_2": "STE. 201",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480381128",
            "telephone_number": "586-412-5110",
            "fax_number": "586-412-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43900 GARFIELD RD",
            "address_2": "STE. 201",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "48038",
            "telephone_number": "586-412-5110",
            "fax_number": "586-412-5116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLAREN MACOMB",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-13",
        "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": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2080P0008X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4168314",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3518937",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3298780",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3298762",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Specialty Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pediatric Specialty Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clinton 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.