SOUTHEASTERN ORTHOPEDICS PC (NPI# 1467630616) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467630616 |
| Entity Type | Organization |
| Organization Name | SOUTHEASTERN ORTHOPEDICS PC |
| Practice Address |
770 Riverside Ave Ste 105 Adrian MI 49221-1476 |
| Practice Telephone | 5172655230 |
| Mailing Telephone | 5172655230 |
| Mailing Fax Number | 5172651535 |
| Enumeration Date | 2008-02-08 |
| Last Update Date | 2008-06-27 |
| Authorized Official Name | BRYAN P SOMERS (SUPERVISOR) |
| Authorized Official Telephone | 5172650229 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 4180319 | 05 | |
| MI | BCBS | 2004611141 | 01 |
| Street Address |
770 RIVERSIDE AVE STE 105 |
| City | ADRIAN |
| State | MI |
| Zip Code | 49221-1476 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497758650 | Asuncion Q Luz | Pediatrics | 770 Riverside Ave, Suite 17, Adrian, MI 49221-1476 | 2005-05-23 |
| 1639699408 | Christopher Donald Valkier | Podiatrist | 770 Riverside Ave, Adrian, MI 49221-1476 | 2017-06-22 |
| 1043690753 | Lisa Schultz | Counselor | 770 Riverside Ave, 11, Adrian, MI 49221-1476 | 2015-06-08 |
| 1710395439 | Tracy Salazar | Counselor | 770 Riverside Ave, Suite 11, Adrian, MI 49221-1445 | 2014-07-25 |
| 1780091751 | Joyce Faulhaber | Counselor | 770 Riverside Ave, Suite 11, Adrian, MI 49221-1476 | 2014-07-22 |
| 1194132449 | Gerald Nelson Mccullough | Counselor | 770 Riverside Ave, Ste 11, Adrian, MI 49221-1476 | 2014-07-18 |
| 1417391673 | Grady Elam | Social Worker | 770 Riverside Ave, Suite 11, Adrian, MI 49221-1476 | 2013-04-18 |
| 1467731117 | Promedica Northwest Ohio Cardiology Consultants, LLC | Internal Medicine | 770 Riverside Ave, Suite 106, Adrian, MI 49221-1476 | 2011-08-12 |
| 1609011311 | Scott R. Smith Dds.,pc | Dentist | 770 Riverside Ave, Suite #201, Adrian, MI 49221-1476 | 2008-12-09 |
| 1487862389 | Chad Burtless-creps | Dentist | 770 Riverside Ave, Suite #200, Adrian, MI 49221-1476 | 2007-05-21 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285116723 | Sandra Ann Harsh | Occupational Therapist | Total Rehab, 1136 Country Club, Adrian, MI 49221 | 2018-08-31 |
| 1588156178 | Chelsea Varney | Social Worker | 1040 Winter Street, Adrian, MI 49221 | 2018-05-31 |
| 1669974127 | Nicoletta Mary Bruno | Physical Therapy Assistant | 700 Lakeshire Trail, Adrian, MI 49221 | 2018-03-01 |
| 1871011403 | Evan Splan | Pharmacist | 1200 South Main St Suite A, Adrian, MI 49221 | 2017-09-04 |
| 1780104992 | Daniel Malcolm | Specialist/Technologist | 1325 Williams St., Adrian, MI 49221 | 2017-06-20 |
| 1639602881 | Robert Gargol | Pharmacist | 1535 W Maumee, Adrian, MI 49221 | 2017-04-05 |
| 1487196416 | Painless Dentistry V | Dentist | 160 N. Winter St., Adrian, MI 49221 | 2016-11-08 |
| 1487025227 | Michelle Lynn Ranta | Speech-Language Pathologist | 730 Kimole Ln., Adrian, MI 49221 | 2015-10-19 |
| 1376929109 | James Hamblin | Technician, Other | 1100 South Main St. Lot 139, Adrian, MI 49221 | 2015-08-04 |
| 1316320039 | Shirley Goodlock | Community/Behavioral Health | 3091 E. Carleton Rd, Adrian, MI 49221 | 2015-06-30 |
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| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487604542 | Jon Michael Maxwell | Orthopaedic Surgery | 227 Riverside Ave, Adrian, MI 49221-1582 | 2006-05-11 |
| 1649239542 | Riccardo Giovannone | Orthopaedic Surgery | 693 Stockford Dr, Adrian, MI 49221-1460 | 2006-03-20 |
| 1831366905 | Adrian Orthopedics PC | Orthopaedic Surgery | 693 Stockford Dr, Adrian, MI 49221-1460 | 2008-05-08 |
| 1598956625 | Bone & Joint Medical Center, PC | Orthopaedic Surgery | 227 Riverside Ave, Adrian, MI 49221-1582 | 2007-08-05 |
| 1932168291 | Michael T Diment | Orthopaedic Surgery | 770 Riverside Ave, Suite 105, Adrian, MI 49221-1476 | 2006-03-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740805365 | Conner D Ahlgren | Orthopaedic Surgery | 3535 W 13 Mile Rd Ste 742, Royal Oak, MI 48073-6770 | 2020-06-09 |
| 1063035319 | Alex Kane Miller | Orthopaedic Surgery | 3577 W 13 Mile Rd Ste 402, Royal Oak, MI 48073-6710 | 2020-05-21 |
| 1396374716 | Arjun Patel | Orthopaedic Surgery | Ascension Genesys, Gme Dept, One Genesys Pkwy, Grand Blanc, MI 48439-4843 | 2020-04-07 |
| 1346876711 | Timothy Curtis Mead | Orthopaedic Surgery | 4752 Lake Harbor Rd, Norton Shores, MI 49441-5236 | 2020-03-18 |
| 1932751112 | Mendelson Warren Pharmacy | Orthopaedic Surgery | 11900 E 12 Mile Rd Ste 105, Warren, MI 48093-3487 | 2019-07-09 |
| 1023678059 | Th Mg Ohio LLC | Orthopaedic Surgery | 1050 Wilshire Dr Ste 300, Troy, MI 48084-1526 | 2019-06-20 |
| 1609430321 | Mohamed Saad-waterworks, PC | Orthopaedic Surgery | 21031 Michigan Ave Fl 2, Dearborn, MI 48124-2339 | 2019-04-29 |
| 1346804135 | Matthew M Astolfi | Orthopaedic Surgery | 3601 W Thirteenth Mile Road, Royal Oak, MI 48073 | 2019-04-26 |
| 1588228845 | Muhammad Talha Padela | Orthopaedic Surgery | 3990 John R St Ste 7b, Detroit, MI 48201 | 2019-04-23 |
| 1134681125 | Neuro Spine Institute Pllc | Orthopaedic Surgery | 29255 Northwestern Hwy Ste 202, Southfield, MI 48034-5741 | 2019-04-01 |
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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.