Eastside Internal Medicine PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301049083 Issued in MI

Legal business name

EASTSIDE INTERNAL MEDICINE PC

Practice address

28315 Harper Ave
Saint Clair Shores, MI 48081-1687

Phone

(586) 552-1710

Fax

(586) 552-1715

NPI assigned

Aug 31, 2006

Last updated

Jul 21, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lori Eckenwiler

Title

Office Manager

Phone

(586) 552-1710

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

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

CLIA laboratory certificates

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Eim Choice Care PC

  • Internal Medicine Physician
  • Saint Clair Shores, MI
  • NPI 1568981025
  NPPES parent name

Practitioners 16

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.

• Muna Beeai, MD

  • Internal Medicine Physician
  • Grosse Pointe Farms, MI
  • NPI 1689676215
  Medicare reassignment NPD
• Stephen Paul D'Addario, MD

  • Internal Medicine Physician
  • Saint Clair Shores, MI
  • NPI 1821006784
  Medicare reassignment NPD
• Eric Newman Neisch, MD

  • Internal Medicine Physician
  • Saint Clair Shores, MI
  • NPI 1225046477
  Medicare reassignment NPD
• Brandon M Ballard, PA-C

  • Physician Assistant
  • Shelby TWP, MI
  • NPI 1588354138
  NPD (past)
• Ann Marie Boeskool, PA-C

  • Physician Assistant
  • Shelby Township, MI
  • NPI 1609004753
  NPD (past)
• Matthew Lee Edwards, D.O,

  • Interventional Cardiology Physician
  • Pontiac, MI
  • NPI 1073877098

  Internal Medicine

  NPD (past)
• Marie Zainea Franz, FNP-BC

  • Family Nurse Practitioner
  • Shelby Township, MI
  • NPI 1184297038
  NPD (past)
• Mouhammed Joumaa, MD

  • Interventional Cardiology Physician
  • Roseville, MI
  • NPI 1316068653

  Cardiovascular Disease

  NPD (past)
• Sherezade Khambatta, DO

  • Interventional Cardiology Physician
  • Shelby Township, MI
  • NPI 1790949741

  Internal Medicine

  NPD (past)
• Nancy Attia Mesiha, MD

  • Cardiovascular Disease Physician
  • Roseville, MI
  • NPI 1952320293
  NPD (past)
• Laura Christine Nielsen, FNP

  • Family Nurse Practitioner
  • Roseville, MI
  • NPI 1598301889
  NPD (past)
• Abdullah Rathur, DO

  • Cardiovascular Disease Physician
  • Shelby Township, MI
  • NPI 1881086163
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311206400000",
    "number": "1831201821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28315 HARPER AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811687",
            "telephone_number": "586-552-1710",
            "fax_number": "586-552-1715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28315 HARPER AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811687",
            "telephone_number": "586-552-1710",
            "fax_number": "586-552-1715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE INTERNAL MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2011-07-21",
        "status": "A",
        "authorized_official_last_name": "ECKENWILER",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "586-552-1710"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301049083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eastlake Cardiovascular PC
• Eastside Associates, LLC (Eastside Endoscopy Center)
• Eastside Eye Physicians, PC
• Eastside Eye Physicians, PC
• Eastside Group LLC
• Eastside Physical Therapy LLC
• Eastside Podiatry PLLC
• Eastside Trauma & Specialty Surgeons
• Margaret Eckel, D.O.
• Thomas Eckert

• Internal Medicine Physician in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2011; 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.