NPIMap

Organization Active NPI

Michigan Neurology Associates PC

  • Neurology Physician
  • Saint Clair Shores, MI
National Provider Identifier
1861498362
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
MICHIGAN NEUROLOGY ASSOCIATES PC
Practice address
19699 E Eight Mile Rd
St Clair Shores, MI 48080
Phone
(586) 445-9900
Fax
(586) 776-4324
NPI assigned
Jun 21, 2005
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Thomas Giancarlo, DONPI 1780627018
Title
President, Michigan Neurology Assoc
Phone
(586) 445-9900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X MI Primary

Addresses

Primary practice location

19699 E Eight Mile Rd
St Clair Shores, MI 48080

Mailing address

19699 E Eight Mile Rd
St Clair Shores, MI 48080
Phone (586) 445-9900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20030423000053 MI Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 8628987468 Practice locations: Clinton Township, MI
O20050330000269 MI Part B Supplier - Clinic/Group Practice 8628987468 Receives reassigned benefits from 47 practitioners
Practice locations: Rochester Hills, MI; Wyandotte, MI; Waterford, MI; Warren, MI; Utica, MI; Sterling Heights, MI; Saint Clair Shores, MI; Mount Clemens, MI…
O20100930003457 MI DME Supplier - Physician - Osteopathic Manipulative Medicine 8628987468 Practice locations: Clinton Township, MI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
23D2028042Michigan Neurology Associates PC19699 E Eight Mile, Saint Clair Shores, MI 48080Certificate of waiverAug 7, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 47

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.

View all 47

NPI Registry JSON

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1861498362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19699 E EIGHT MILE RD",
            "city": "ST CLAIR SHORES",
            "state": "MI",
            "postal_code": "48080",
            "telephone_number": "586-445-9900",
            "fax_number": "586-776-4324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19699 E EIGHT MILE RD",
            "city": "ST CLAIR SHORES",
            "state": "MI",
            "postal_code": "48080",
            "telephone_number": "586-445-9900",
            "fax_number": "586-776-4324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN NEUROLOGY ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-21",
        "last_updated": "2022-07-21",
        "certification_date": "2022-01-18",
        "status": "A",
        "authorized_official_last_name": "GIANCARLO",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT, MICHIGAN NEUROLOGY ASSOC",
        "authorized_official_telephone_number": "586-445-9900",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": null,
            "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 Jul 21, 2022; 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.