ST JOHN HOSPITAL AND MEDICAL CENTER (NPI# 1144460676) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144460676 |
| Entity Type | Organization |
| Organization Name | ST JOHN HOSPITAL AND MEDICAL CENTER |
| Practice Address |
22101 Moross Rd Detroit MI 48236-2148 |
| Mailing Address |
28800 Dequindre Rd Warren MI 48092-2466 |
| Practice Telephone | 5867530011 |
| Mailing Telephone | 5867530011 |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2009-02-24 |
| Authorized Official Name | SUSAN FIELD (SR DIRECTOR) |
| Authorized Official Telephone | 5867530011 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367H00000X | Anesthesiologist Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BLUE CROSS | 0866958 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801198387 | St John Hospital and Medical Center | Clinic/Center | 17700 23 Mile Rd, Ste 200, Macomb, MI 48044-1154 | 2010-12-03 |
| 1760708945 | St John Hospital and Medical Center | Audiologist | 28000 Dequindre Rd, Warren, MI 48092-2468 | 2010-04-14 |
| 1164655585 | St John Hospital and Medical Center | Internal Medicine | 19229 Mack Ave, 24, Grosse Pointe Woods, MI 48236-2858 | 2009-09-02 |
| 1831338581 | St John Hospital and Medical Center | Dermatology | 22101 Moross Rd, Detroit, MI 48236-2148 | 2009-02-19 |
| 1346488863 | St John Hospital and Medical Center | Podiatrist | 22101 Moross Rd, Detroit, MI 48236-2148 | 2009-01-22 |
| 1891933313 | St John Hospital and Medical Center | Surgery | 22101 Moross Rd, Detroit, MI 48236-2148 | 2009-01-22 |
| 1750546446 | St John Hospital and Medical Center | Radiologic Technologist | 20225 E 9 Mile Rd, Saint Clair Shores, MI 48080-1775 | 2008-07-23 |
| 1740445337 | St John Hospital and Medical Center | Radiology | 46591 Romeo Plank Rd, Suite 137, Macomb, MI 48044-5742 | 2008-07-23 |
| 1083873525 | St John Hospital and Medical Center | Internal Medicine | 22101 Moross Rd, Detroit, MI 48236-2148 | 2008-06-09 |
| 1609035229 | St John Hospital and Medical Center | Internal Medicine | 22101 Moross Rd, Detroit, MI 48236-2148 | 2008-06-09 |
| Street Address |
22101 MOROSS RD |
| City | DETROIT |
| State | MI |
| Zip Code | 48236-2148 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083609887 | Anne M Schneider | Obstetrics & Gynecology | 22101 Moross Rd, 313, Detroit, MI 48236-2148 | 2005-09-19 |
| 1346848827 | Tanya L Locke | Nurse Practitioner | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-10-15 |
| 1588261556 | Ryan Guthrie | Student in an Organized Health Care Education/Training Program | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-10-02 |
| 1578160743 | Lauren Kudirka | Speech-Language Pathologist | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-10-01 |
| 1952918740 | Lisa Colombo | Nurse Practitioner | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-09-26 |
| 1124635917 | Gjergj George Juncaj | Nurse Practitioner | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-09-26 |
| 1194337881 | Lori Holaly | Nurse Practitioner | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-08-23 |
| 1548870066 | Tamara Siblini | Student in an Organized Health Care Education/Training Program | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-08-10 |
| 1104436583 | David Mark Thomas | Student in an Organized Health Care Education/Training Program | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-07-31 |
| 1780293969 | Alexander Swend Mortensen | Student in an Organized Health Care Education/Training Program | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-07-23 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093323966 | Khairya Fatouh | Pathology | 22101 Morros Road, Pathology Department, Detroit, Detroit, MI 48236 | 2020-07-16 |
| 1134744998 | Harish Harry Gidda | Internal Medicine | 22201 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-06-08 |
| 1770107443 | Arshan Ali Khan | Internal Medicine | 22101 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-05-29 |
| 1750901658 | Annika Van Wieren | Emergency Medicine | 22101 Moross Road, Emergency Department, Detroit, MI 48236 | 2020-04-21 |
| 1801449483 | Ishaq Azeem Asghar | Student in an Organized Health Care Education/Training Program | 22101 Moross Road, Pathology Department, Detroit, MI 48236 | 2019-07-22 |
| 1295290443 | Ascension St. John Hospital | Dietitian, Registered | 22201 Moross, Ste. 270, Detriot, MI 48236 | 2019-02-01 |
| 1548747413 | Abiodun Adenuga Adefarasin | Pharmacist | 20746 Mack Avenue, Gross Pointe Woods, MI 48236 | 2018-07-24 |
| 1629564042 | Hamza H Khan | Student in an Organized Health Care Education/Training Program | 22201 Moross, Professional Building 2, Suite 70, Detroit, MI 48236 | 2018-07-09 |
| 1235631664 | David Lee Williams | Physical Therapist | 159 Kercheval Avenue, Grosse Pointe Farms, MI 48236 | 2018-03-01 |
| 1164979720 | Memphie Morgan | Licensed Practical Nurse | 91527 Cheshire St., Grosse Pointe, MI 48236 | 2016-09-01 |
| Find all providers in zip 48236 | ||||
| Taxonomy Code | 367H00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Anesthesiologist Assistant |
| An individual certified by the state to perform anesthesia services under the direct supervision of an anesthesiologist. Anesthesiologist Assistants are required to have a bachelor's degree with a premed curriculum prior to entering a two-year anesthesiology assistant program, which is focused upon the delivery and maintenance of anesthesia care as well as advanced patient monitoring techniques. An Anesthesiologist Assistant must work as a member of the anesthesia care team under the direction of a qualified Anesthesiologist. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275621682 | James Albert Sharp Jr. | Anesthesiologist Assistant | 22101 Moross Rd, Detroit, MI 48236-2148 | 2006-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205454998 | Andrea Mantel | Anesthesiologist Assistant | 3333 Evergreen Dr Ne, Grand Rapids, MI 49525-9493 | 2020-07-08 |
| 1316586381 | Keith Minbiole | Anesthesiologist Assistant | 100 Michigan St Ne, Grand Rapids, MI 49503-2560 | 2019-12-23 |
| 1427697499 | Alexander Linkner | Anesthesiologist Assistant | 100 Michigan St Ne, Grand Rapids, MI 49503-2560 | 2019-12-23 |
| 1811541774 | Skylar Bayer | Anesthesiologist Assistant | 100 Michigan St Ne, Grand Rapids, MI 49503-2560 | 2019-07-30 |
| 1659834562 | Kevin Sistani | Anesthesiologist Assistant | 100 Michigan St Ne, Grand Rapids, MI 49503 | 2019-04-08 |
| 1497217335 | Nicholas Simpson | Anesthesiologist Assistant | 3333 Evergreen Dr Ne, Grand Rapids, MI 49525-9493 | 2019-04-01 |
| 1841796752 | Mason Fisher | Anesthesiologist Assistant | 3333 Evergreen Dr Ne, Grand Rapids, MI 49525-9493 | 2018-04-02 |
| 1134645963 | Meghan Fowler | Anesthesiologist Assistant | 3333 Evergreen Dr Ne, Grand Rapids, MI 49525-9493 | 2017-08-14 |
| 1689046070 | Southgate Allied Anesthesia Pllc | Anesthesiologist Assistant | 13460 Fort St, Southgate, MI 48195-1138 | 2015-10-24 |
| 1578943247 | Starwood Precision Anesthesia Pllc | Anesthesiologist Assistant | 13460 Fort St, Southgate, MI 48195-1138 | 2015-06-08 |
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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.