NPIMap

Organization Active NPI

Surgical Consultants PLLC

  • Surgery Physician
  • Mount Clemens, MI
National Provider Identifier
1891708814
Registry record updated May 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
5101013083 Issued in MI
Legal business name
SURGICAL CONSULTANTS PLLC
Practice address
1030 Harrington St
302A
Mount Clemens, MI 48043-2967
Phone
(586) 759-2005
Fax
(586) 759-2636
NPI assigned
Aug 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2015

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

Authorized official

Name
Mandip S Atwal, D.O.NPI 1972573061
Title
Partner
Phone
(586) 759-2005

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
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 5101013083 MI Primary

Addresses

Primary practice location

1030 Harrington St
302A
Mount Clemens, MI 48043-2967

Mailing address

1030 Harrington St
Suite 302a
Mount Clemens, MI 48043-2967
Phone (586) 759-2005

Other identifiers 3

IdentifierTypeStateIssuer
114446930MedicaidMI
114528179MedicaidMI
0E01555OtherMIBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060315000253 MI Part B Supplier - Clinic/Group Practice 6800803917 Receives reassigned benefits from 3 practitioners
Practice locations: Mount Clemens, MI; Detroit, MI; Clinton Township, MI

National Provider Directory

National Provider Directory

Locations

1030 Harrington St
Ste 302A
Mount Clemens, MI 48043
Phone (586) 759-2005

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432598400000",
    "number": "1891708814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 HARRINGTON ST",
            "address_2": "SUITE 302A",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432967",
            "telephone_number": "586-759-2005",
            "fax_number": "586-759-2636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 HARRINGTON ST",
            "address_2": "302A",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432967",
            "telephone_number": "586-759-2005",
            "fax_number": "586-759-2636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICAL CONSULTANTS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2015-05-26",
        "status": "A",
        "authorized_official_last_name": "ATWAL",
        "authorized_official_first_name": "MANDIP",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "586-759-2005",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "MI",
            "license": "5101013083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114446930",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114528179",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0E01555",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Clemens, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.