SOUTHSIDE MEDICAL CENTER INC (NPI# 1245636885) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245636885 |
| Entity Type | Organization |
| Organization Name | SOUTHSIDE MEDICAL CENTER INC |
| Practice Address |
5525 S Martin Luther King Jr Blvd Lansing MI 48911-3546 |
| Practice Telephone | 5179133888 |
| Mailing Telephone | 5179133888 |
| Enumeration Date | 2014-11-10 |
| Last Update Date | 2014-11-10 |
| Authorized Official Name | DOUGLAS VANDERJACT (OWNER) |
| Authorized Official Telephone | 5179133888 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | INDIVIDUAL NPI | 1730121880 | 01 |
| Street Address |
5525 S MARTIN LUTHER KING JR BLVD |
| City | LANSING |
| State | MI |
| Zip Code | 48911-3546 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083923841 | Candace Kay Wixson-johnson | Physician Assistant | 5525 S Martin Luther King Jr Blvd, Lansing, MI 48911-3546 | 2010-09-28 |
| 1023615135 | Tiffany Louise Gose | Physician Assistant | 5525 S Martin Luther King Jr Blvd, Lansing, MI 48911-3546 | 2020-10-02 |
| 1801365747 | Caitlan Lindsay Herron | Physician Assistant | 5525 S Martin Luther King Jr Blvd, Lansing, MI 48911-3546 | 2018-11-21 |
| 1124508460 | Andrea Schrecongost | Physician Assistant | 5525 S Martin Luther King Jr Blvd, Lansing, MI 48911 | 2018-08-16 |
| 1114411295 | Sandra Pollard | Nurse Practitioner | 5525 S Martin Luther King Jr Blvd, Lansing, MI 48911-3546 | 2018-06-21 |
| 1790224079 | Ifeyinwa Ajumobi | Physician Assistant | 5525 S Martin Luther King Jr Blvd, Lansing, MI 48911-3546 | 2017-02-20 |
| 1760861777 | Nyebol B Madut | Family Medicine | 5525 S Martin Luther King Jr Blvd, Lansing, MI 48911 | 2015-05-22 |
| 1609266204 | Mclaren Greater Lansing | Emergency Medicine | 5525 S Martin Luther King Jr Blvd, Lansing, MI 48911 | 2015-02-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154943603 | Promissa Personalized Care Services LLC | Assisted Living Facility | 200 E Edgewood Blvd, Lansing, MI 48911 | 2020-05-07 |
| 1457911877 | Zachary Todd Goldstein | Pediatrics | Cedar Pediatrics 5303 S. Cedar St, Suite 205, Lansing, MI 48911 | 2019-06-18 |
| 1447713946 | Fadi Nuseibeh | Pharmacist | 3955 Patient Care Drive, Pharmacy, Lansing, MI 48911 | 2019-04-11 |
| 1740704543 | Kyle Lardie | Dental Hygienist | Care Free Medical and Dental 5135 S Pennsylvania Ave, Lansing, MI 48911 | 2017-08-02 |
| 1124549845 | Joash Michael Charles | Behavior Technician | 3720 Richmond Street, Lansing, MI 48911 | 2017-07-03 |
| 1205212164 | Benjamin Curtis Neal | Dentist | 5601 S Cedar St., Lansing, MI 48911 | 2015-08-03 |
| 1376927608 | Heather Lamb | Home Health | 2919 Risdale St, Lansing, MI 48911 | 2015-07-16 |
| 1669861712 | Lucas James Evan Joseph Bila | Licensed Practical Nurse | 2204 S. Wadsworth Dr, Lansing, MI 48911 | 2015-01-13 |
| 1649695271 | Aaron James Hart | Occupational Therapist | 3960 Patient Care Dr Ste 117, Lansing, MI 48911 | 2014-02-18 |
| 1831465871 | Los Equipment Corporation | Dentist | 6810 S. Cedar St, Suite 5, Lansing, MI 48911 | 2012-03-23 |
| Find all providers in zip 48911 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790399798 | Enhua Wang | Internal Medicine | 1215 E Michigan Ave Ste 500, Lansing, MI 48912-1811 | 2020-09-07 |
| 1982235768 | Pine Point Medical, Pllc | Internal Medicine | 3105 N. Triphammer Road, Suite 7, Lansing, NY 14882-8906 | 2020-01-30 |
| 1487154290 | Edward W Sparrow Hospital Association | Internal Medicine | 1200 E Michigan Ave Ste 510, Lansing, MI 48912-1899 | 2018-02-19 |
| 1770094153 | Thomas M Bergren | Internal Medicine | 110 E Allegan St Apt 1, Lansing, MI 48933-1852 | 2017-10-12 |
| 1740543180 | Sundeev Singh Gill | Internal Medicine | 3955 Patient Care Dr Ste B, Lansing, MI 48911-4271 | 2012-06-20 |
| 1578837332 | Robert Russell Hillman | Internal Medicine | 1215 E Michigan Ave # 7, Lansing, MI 48912-1811 | 2012-02-26 |
| 1205147873 | Joshua P June | Internal Medicine | 3394 E Jolly Rd Ste C, Lansing, MI 48910-8595 | 2010-06-28 |
| 1790001816 | Fatima Sultan | Internal Medicine | 1200 E. Michigan Ave Ste 500, Lansing, MI 48912 | 2010-04-14 |
| 1790007359 | Thomas Louis Schneider | Internal Medicine | 920 Townsend St, Mc 489-066-046, Lansing, MI 48921-0001 | 2010-02-24 |
| 1376873760 | Soumya Madala Md Pllc | Internal Medicine | 3937 Patient Care Way Ste 102, Lansing, MI 48911-4287 | 2010-01-06 |
| Find all providers in LANSING | ||||
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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.