Sjmo Bald Mountain

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SJMO BALD MOUNTAIN

Practice address

1375 S Lapeer Rd
Suite 160
Lake Orion, MI 48360-1421

Phone

(248) 693-9040

Fax

(248) 693-9007

NPI assigned

Feb 12, 2008

Organization subpart

Yes

Parent organization

TRINITY HEALTH-MICHIGANAs reported in NPPES

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

Authorized official

Name

Jack Weiner

Title

Ceo

Phone

(248) 858-3140

Specialties & licenses 3

Addresses

Part of

Mercy Health Services

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

{
    "created_epoch": "1202774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202774400000",
    "number": "1922276013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1375 S LAPEER RD",
            "address_2": "SUITE 160",
            "city": "LAKE ORION",
            "state": "MI",
            "postal_code": "483601421",
            "telephone_number": "248-693-9040",
            "fax_number": "248-693-9007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1375 S LAPEER RD",
            "address_2": "SUITE 160",
            "city": "LAKE ORION",
            "state": "MI",
            "postal_code": "483601421",
            "telephone_number": "248-693-9040",
            "fax_number": "248-693-9007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SJMO BALD MOUNTAIN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRINITY HEALTH-MICHIGAN",
        "enumeration_date": "2008-02-12",
        "last_updated": "2008-02-12",
        "status": "A",
        "authorized_official_last_name": "WEINER",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "248-858-3140"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jodi Jean Sides, OTR/L
• Erin Simmerman, NP-C
• Sincere Hearts Medical Equipment & Supplies Inc.
• Sizops Inc
• Sizops Inc
• Karen Slattery, MSW, LCAC, CAAC
• Karen Renee Smigelski, MA, LPC, CAADC
• Billy Smith, CADC
• Crystal Eva Smith, MA LPC NCC
• Jeffery David Smith, OTRL

• Family Medicine Physician in Lake Orion, MI
• Providers in Lake Orion, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2008; 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.