NPIMap

Individual provider Active NPI

Jerald Purifoy, MD

  • Pediatrics Physician
  • Southgate, MI
National Provider Identifier
1902979495
Registry record updated Oct 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4301051144 Issued in MI
Practice address
15777 Northline Rd Ste 203
Southgate, MI 48195-2354
Phone
(734) 246-8100
NPI assigned
Nov 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine Physician 2080N0001X 4301051144 MI
Pediatrics Physician 208000000X 4301051144 MI Primary

Addresses

Primary practice location

15777 Northline Rd Ste 203
Southgate, MI 48195-2354

Mailing address

26901 Beaumont Blvd Ste 3D
Southfield, MI 48033-3849

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jpurifoy116605@direct.beaumont.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301051144MIMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oakwood Ambulatory, LLC PastSince Oct 25, 2020 Accepting new patients
Oakwood Healthcare Inc PastSince Oct 25, 2020 Accepting new patients
Oakwood Ambulatory LLC Pediatrics Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1902979495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15777 NORTHLINE RD STE 203",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952354",
            "telephone_number": "734-246-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PURIFOY",
        "first_name": "JERALD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "MI",
            "license": "4301051144",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301051144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpurifoy116605@direct.beaumont.org",
            "affiliation": "N",
            "address_1": "15777 Northline Rd Ste 203",
            "city": "Southgate",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481952354",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Southgate, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; 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.