ASCENSION PROVIDENCE HOSPITAL (NPI# 1003871062) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003871062 |
| Entity Type | Organization |
| Organization Name | ASCENSION PROVIDENCE HOSPITAL |
| Other Organization Name | PH NEONATOLOGY/PROVIDENCE HOSPTIAL AND MEDICAL CENTERS INC |
| Practice Address |
16001 W 9 Mile Rd Southfield MI 48075-4818 |
| Mailing Address |
43750 Garfield Rd 211 Clinton Twp MI 48038-1135 |
| Practice Telephone | 2488493000 |
| Practice Fax Number | 2488492244 |
| Mailing Telephone | 5862284550 |
| Mailing Fax Number | 5862266962 |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2018-12-04 |
| Authorized Official Name | SARAH STARKEL (CREDENTIALING COORDINATOR) |
| Authorized Official Telephone | 2486808121 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | MI BLUE CROSS GROUP PIN # | 350F360230 | 01 |
| Other Name | Type Code |
|---|---|
| PH Neonatology/Providence Hosptial and Medical Centers Inc | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225093776 | Ascension Providence Hospital | Nuclear Medicine | 2800 Livernois Rd, Blgd D Suite 500, Troy, MI 48083-1215 | 2006-04-19 |
| 1003892092 | Ascension Providence Hospital | Psychiatric Unit | 16001 W. 9 Mile Road, Southfield, MI 48075-4818 | 2005-12-21 |
| 1043385909 | Ascension Providence Hospital | General Acute Care Hospital | 47601 Grand River Ave, Novi, MI 48374-1233 | 2006-11-22 |
| 1851339196 | Ascension Providence Hospital | Nurse Anesthetist, Certified Registered | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2006-06-02 |
| 1629033683 | Ascension Providence Hospital | Internal Medicine | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2006-04-20 |
| 1265497226 | Ascension Providence Hospital | Pediatrics | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2006-04-20 |
| 1619932670 | Ascension Providence Hospital | Psychiatry & Neurology | 16001 W 9 Mile Rd, Physician Billing Services, Southfield, MI 48075-4818 | 2006-04-20 |
| 1528023587 | Ascension Providence Hospital | Psychologist | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2006-04-20 |
| 1235194291 | Ascension Providence Hospital | Internal Medicine | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2006-04-20 |
| 1144285107 | Ascension Providence Hospital | General Practice | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2006-04-20 |
| Street Address |
16001 W 9 MILE RD |
| City | SOUTHFIELD |
| State | MI |
| Zip Code | 48075-4818 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114929338 | Sally Rae Arbuckle | Registered Nurse | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2005-06-01 |
| 1730780651 | Jennifer Bekes | Nurse Anesthetist, Certified Registered | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2020-11-06 |
| 1497361133 | Matthew Hoffman | Nurse Anesthetist, Certified Registered | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2020-09-18 |
| 1447866215 | Marisa Mcalister | Nurse Practitioner | 16001 W 9 Mile Rd, Southfield, MI 48075-4803 | 2020-09-17 |
| 1629682935 | John Michael Faraj | Registered Nurse | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2020-09-03 |
| 1861017337 | Adnan Basheer | Internal Medicine | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2020-06-10 |
| 1891319885 | Seti Kelemework Belay | Radiology | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2020-06-04 |
| 1467076851 | Alexa Rae Arvidson | Internal Medicine | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2020-06-02 |
| 1275157638 | Angela Niezgoda | Obstetrics & Gynecology | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2020-06-02 |
| 1942824453 | Marc Thomas Zughaib | Internal Medicine | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2020-06-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851900054 | K&b Medical Wigs, LLC | Durable Medical Equipment & Medical Supplies | 16250 Northland Dr. Ste 221, Southfield, MI 48075 | 2020-07-24 |
| 1790300390 | Julian Jeberaeel | Radiology | 2250 Providence, Southfield, MI 48075 | 2020-06-10 |
| 1265056410 | Husein Yusuf Husein | Podiatrist | Ascension Providence Hospital Southfield Campus, 16001 W. Nine Mile Rd. Depaul 2nd Floor, Southfield, Mi, MI 48075 | 2020-06-03 |
| 1952945420 | Paris Straughter | Nurse Practitioner | 18438 Onyx St, Southfield, MI 48075 | 2019-10-29 |
| 1811467657 | Medicine Man Medical, Pllc | Physical Medicine & Rehabilitation | 25130 Southfield Road, Suite #210, Southfield, MI 48075 | 2018-12-04 |
| 1447725528 | Rommel Ramos Perez | Physical Therapist | 26017 Greenfield Rd., Southfield, MI 48075 | 2018-10-04 |
| 1073009627 | Jacqueline Venora Goodgame | Licensed Practical Nurse | 4000 Town Ctr, Southfield, MI 48075 | 2018-07-06 |
| 1043712532 | Hollie Marie Maltese | Physical Therapy Assistant | 22255 Greenfiled 118, Southfield, MI 48075 | 2018-03-01 |
| 1932601481 | Katie Marie Mccormack | Occupational Therapist | 16001 West Nine Mile Rd., Southfield, MI 48075 | 2018-03-01 |
| 1801304241 | Absolute Hc LLC | Physical Therapist | 23461 Greenfield Rd Ste 200b, Southfield, MI 48075 | 2018-01-19 |
| Find all providers in zip 48075 | ||||
| Taxonomy Code | 2080N0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Neonatal-Perinatal Medicine |
| A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588656987 | Shahid Khan | Pediatrics | 16001 W 9 Mile Rd, Dept of Neonatology, Southfield, MI 48075-4818 | 2005-08-22 |
| 1881694925 | Swarajyalxmi Burugupalli Rao | Pediatrics | 16001 W 9 Mile Rd, Dept of Neonatology, Southfield, MI 48075-4818 | 2005-07-29 |
| 1023015450 | Betty Yu Go | Pediatrics | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2005-06-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477022721 | Stephanie A Cody | Pediatrics | 4625 2nd Ave Apt 109, Detroit, MI 48201-1238 | 2018-11-15 |
| 1427494889 | Danish Alamshahi Alamy Md | Pediatrics | 1 Hurley Plz # 2e, Flint, MI 48503-5902 | 2013-05-13 |
| 1073855482 | Jodi K. Garvin | Pediatrics | Helen De Vos Children's Hospital Nicu 3w, 100 Michigan St Ne, Grand Rapids, MI 49503-2560 | 2013-03-24 |
| 1205052636 | Neonatology & Inpatient Pediatrics, Inc | Pediatrics | 1964 Westlake Ct, Bloomfield Hills, MI 48302-1286 | 2007-04-17 |
| 1912933771 | June C Murphy | Pediatrics | 1400 Genesys Pkwy, Grand Blanc, MI 48439-8068 | 2006-06-24 |
| 1922096718 | William D Clark | Pediatrics | 18101 Oakwood Blvd Ste 124, Dearborn, MI 48124-4089 | 2005-10-06 |
| 1477188555 | Msu Health Care Inc | Pediatrics | 1215 E Michigan Ave, Lansing, MI 48912-1811 | 2020-03-09 |
| 1528608411 | Carl Joseph Domigan | Pediatrics | 1500 E Medical Center Dr, Ann Arbor, MI 48109-5000 | 2020-01-08 |
| 1790334217 | Adila Mohammedfawzi Abulhamail | Pediatrics | 1215 E Michigan Ave, Lansing, MI 48912-1811 | 2019-09-06 |
| 1558910216 | Mishref Mohammed Abdelhamid | Pediatrics | 1215 E Michigan Ave, Lansing, MI 48912-1811 | 2019-09-05 |
| Find all providers with the same taxonomy | ||||
| City | SOUTHFIELD |
| Zip Code | 48075 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.