Southeastern Michigan Medical Consultants PC

Primary specialty

Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X

License

4301044898 Issued in MI

Legal business name

SOUTHEASTERN MICHIGAN MEDICAL CONSULTANTS PC

Practice address

21420 Harper Ave
Suite 2
Saint Clair Shores, MI 48080-3607

Phone

(586) 775-7400

Fax

(586) 775-0091

NPI assigned

Sep 22, 2006

Last updated

Feb 6, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Rudy Jerome Vervaeke, MDNPI 1922108927

Title

Ceo

Phone

(586) 775-7400

Specialties & licenses 1

Addresses

Other identifiers 6

Locations

Practitioners 1

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.

• Rudy Jerome Vervaeke, M.D.

  • Addiction Medicine (Internal Medicine) Physician
  • Saint Clair Shores, MI
  • NPI 1922108927
  Authorized official Same address or phone

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423180800000",
    "number": "1942300884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21420 HARPER AVE",
            "address_2": "SUITE 2",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480803607",
            "telephone_number": "586-775-7400",
            "fax_number": "586-775-0091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21420 HARPER AVE",
            "address_2": "SUITE 2",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480803607",
            "telephone_number": "586-775-7400",
            "fax_number": "586-775-0091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN MICHIGAN MEDICAL CONSULTANTS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2015-02-06",
        "status": "A",
        "authorized_official_last_name": "VERVAEKE",
        "authorized_official_first_name": "RUDY",
        "authorized_official_middle_name": "JEROME",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "586-775-7400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "MI",
            "license": "4301044898",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4329604",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "DE9629",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "010E023690",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN",
            "identifier": "010E023690",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAP",
            "identifier": "B47051",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942300884",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sommerville Audiology, LLC
• Jaclyn Marie Sommerville, AU.D, CCC-A
• Sophisti Cuts LTD Go Green Salon
• David Maurice Sorbo, D.D.S.
• Emianka Sotiri, MD
• Colin Southway
• Sparc Speech and Language Therapy Services LLC
• Sydney Allyn Spatafore, TLLP
• Jalyn Spencer-Harris, IBCLC
• Taylor Sheridan Spencer, BCBA

• Addiction Medicine (Internal Medicine) Physician in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Addiction Medicine (Internal Medicine) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2015; 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.