NPIMap

Organization Active NPI

Child and Adolescent Center P C

  • Pediatrics Physician
  • Southgate, MI
National Provider Identifier
1952498875
Registry record updated Dec 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CHILD AND ADOLESCENT CENTER P C
Practice address
15350 Trenton Rd
Southgate, MI 48195-2027
Phone
(734) 283-4616
Fax
(734) 283-5430
NPI assigned
Oct 10, 2006
Last updated
Dec 13, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2011

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

Authorized official

Name
Paula Green
Title
Office Manager
Phone
(734) 283-4616

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

15350 Trenton Rd
Southgate, MI 48195-2027

Mailing address

15350 Trenton Rd
Southgate, MI 48195-2027
Phone (734) 283-4616

Other identifiers 1

IdentifierTypeStateIssuer
350H27736OtherMIBCBSM PROVIDER ID NUMBER

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0369176Child & Adolescent Center, P C15350 Trenton Rd, Southgate, MI 48195Certificate of waiverOct 16, 2027

National Provider Directory

National Provider Directory

Locations

15350 Trenton Rd
Southgate, MI 48195
Phone (734) 283-4616

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323734400000",
    "number": "1952498875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15350 TRENTON RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952027",
            "telephone_number": "734-283-4616",
            "fax_number": "734-283-5430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15350 TRENTON RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952027",
            "telephone_number": "734-283-4616",
            "fax_number": "734-283-5430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILD AND ADOLESCENT CENTER P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2011-12-13",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "PAULA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "734-283-4616"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM PROVIDER ID NUMBER",
            "identifier": "350H27736",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "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 Dec 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.