NPIMap

Organization Active NPI

Henry Ford Health Providence Hospital

Doing business as Henry Ford Providence Hospital

  • Surgery Physician
  • Southfield, MI
National Provider Identifier
1942265236
Registry record updated Jul 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
HENRY FORD HEALTH PROVIDENCE HOSPITAL
Doing business as
Henry Ford Providence Hospital
Practice address
16001 W 9 Mile Rd
Southfield, MI 48075-4818
Phone
(248) 849-3000
Fax
(248) 849-2244
NPI assigned
Apr 19, 2006
Last updated
Jul 16, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2026

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

Authorized official

Name
Kimberly Cebalt
Title
Director
Phone
(313) 874-6764

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X NU
Orthopaedic Surgery Physician 207X00000X NU
Surgery Physician 208600000X NU Primary
Colon & Rectal Surgery Physician 208C00000X NU
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X NU

Addresses

Primary practice location

16001 W 9 Mile Rd
Southfield, MI 48075-4818

Mailing address

PO Box 670884
Detroit, MI 48267-0884
Phone (800) 999-5829

Other identifiers 1

IdentifierTypeStateIssuer
020F364690OtherMIMI BLUE CROSS GROUP PIN#

Other names 2

  • HENRY FORD PROVIDENCE HOSPITAL Doing business as
  • PH General Surgery/Providence Hospital and Medical Centers Inc Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031103000326 MI Part B Supplier - Clinic/Group Practice 6103738703 Receives reassigned benefits from 466 practitioners
14 other NPIs on this enrollment

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory

Locations

30055 Northwestern Hwy
Farmington Hills, MI 48334
Phone (248) 626-8200

Practitioners & affiliated clinicians

Practitioners 476

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 476

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784160000000",
    "number": "1942265236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 670884",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482670884",
            "telephone_number": "800-999-5829",
            "fax_number": "248-641-4840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16001 W 9 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754818",
            "telephone_number": "248-849-3000",
            "fax_number": "248-849-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENRY FORD HEALTH PROVIDENCE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-19",
        "last_updated": "2026-07-16",
        "certification_date": "2026-07-16",
        "status": "A",
        "authorized_official_last_name": "CEBALT",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "313-874-6764"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI BLUE CROSS GROUP PIN#",
            "identifier": "020F364690",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HENRY FORD PROVIDENCE HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PH General Surgery/Providence Hospital and Medical Centers Inc",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "PH General Surgery/Providence Hospital and Medical Centers Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2026; 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.