ST JOHN HOSPITAL AND MEDICAL CENTER (NPI# 1922139880) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922139880 |
| Entity Type | Organization |
| Organization Name | ST JOHN HOSPITAL AND MEDICAL CENTER |
| Practice Address |
22151 Moross Rd Suite 313 Detroit MI 48236-2167 |
| Mailing Address |
28000 Dequindre Rd Warren MI 48092-2468 |
| Practice Telephone | 5867530011 |
| Mailing Telephone | 5867530011 |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2009-01-28 |
| Authorized Official Name | MR. CHRISTOPHER J PALAZZOLO (V.P. - FINANCE) |
| Authorized Official Telephone | 3133433558 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207VM0101X |
Obstetrics & Gynecology Specialization: Maternal & Fetal Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBSM PIN | 0Q26061 | 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 |
| 1144460676 | St John Hospital and Medical Center | Anesthesiologist Assistant | 22101 Moross Rd, Detroit, MI 48236-2148 | 2009-02-24 |
| 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 |
| Street Address |
22151 MOROSS RD SUITE 313 |
| City | DETROIT |
| State | MI |
| Zip Code | 48236-2167 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366440463 | Christine Ann Crader | Internal Medicine | 22151 Moross Rd, Detroit, MI 48236-2167 | 2005-07-12 |
| 1467078857 | Anirudh Kotha | Student in an Organized Health Care Education/Training Program | 22151 Moross Rd, Ste 214, Detroit, MI 48236 | 2020-06-22 |
| 1386147981 | Carla Freigeh | Physician Assistant | 22151 Moross Rd, Detroit, MI 48236-2167 | 2018-03-10 |
| 1245738822 | Stacey Alise Joiner | Counselor | 22151 Moross Rd, Detroit, MI 48236-2167 | 2018-01-29 |
| 1730618158 | Victoria Elizabeth Simmons | Surgery | 22151 Moross Rd, Suite 214, Detroit, MI 48236 | 2017-06-08 |
| 1902356272 | Jisha Dudeesh | Nurse Practitioner | 22151 Moross Rd, Professional Building One, Detroit, MI 48236-2167 | 2016-10-10 |
| 1841740792 | Celia Shallal | Social Worker | 22151 Moross Rd, Pb1, Detroit, MI 48236-2167 | 2016-10-04 |
| 1841668308 | Moayad Tarboush | Student in an Organized Health Care Education/Training Program | 22151 Moross Rd, Detroit, MI 48236-2167 | 2015-09-14 |
| 1285023226 | Lauren Krist | Nurse Practitioner | 22151 Moross Rd, Detroit, MI 48236-2167 | 2015-01-14 |
| 1194122937 | Patricia Vassallo | Nurse Practitioner | 22151 Moross Rd, Pb 2 Suite 209, Detroit, MI 48236-2167 | 2014-11-21 |
| Find all providers in the same location | ||||
| 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 | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952909558 | Quilted Rose Clinical Services, Pllc | Clinic/Center | 269 Walker St Ste 256, Detroit, MI 48207-4258 | 2020-10-15 |
| 1851920581 | Emotional Wellness Group LLC | Clinic/Center | 11956 E Outer Dr, Detroit, MI 48224-2630 | 2020-04-04 |
| 1245897503 | Healthy Choice Community Centered Counseling LLC | Clinic/Center | 19300 Greenfield Rd Ste B, Detroit, MI 48235-2003 | 2019-05-22 |
| 1891245775 | Platinum Psychological Services | Clinic/Center | 4777 E Outer Dr Ste 1154, Detroit, MI 48234-3241 | 2016-10-04 |
| 1750837324 | A Plus Care Transportation LLC | Clinic/Center | 14586 Wisconsin, Detroit, MI 48238 | 2016-09-01 |
| 1093157802 | Medical Massage Clinic of Mi., LLC | Clinic/Center | 17151 Wyoming St, Detroit, MI 48221-2451 | 2013-07-22 |
| 1033461728 | Caring Hands Medical Clinical, P.C. | Clinic/Center | 14219 W. Mc Nichols Road, Detroit, MI 48235 | 2012-10-05 |
| 1558619510 | St John Providence Eastwood Clinic | Clinic/Center | 4777 E Outer Dr Ste 1105, Detroit, MI 48234-3241 | 2012-08-23 |
| 1497997068 | Med Care Clinic LLC | Clinic/Center | 16315 Grand River Ave, Detroit, MI 48227-1825 | 2009-03-29 |
| 1841448446 | Theramatrix, Inc. | Clinic/Center | 18601 Mack Avenue #3, Detroit, MI 48236-3250 | 2008-09-08 |
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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.