PROVIDENCE-PROVIDENCE PARK HOSPITAL (NPI# 1780649822) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780649822 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE-PROVIDENCE PARK HOSPITAL |
| Other Organization Name | PH NURSE PRACTITIONERS/PROVIDENCE HOSPITAL AND MEDICAL CENTERS INC |
| Practice Address |
16001 W 9 Mile Rd Physician Billing Services Southfield MI 48075-4818 |
| Mailing Address |
2800 Livernois Rd Suite 500 Troy MI 48083-1215 |
| Practice Telephone | 2488493000 |
| Practice Fax Number | 2488492244 |
| Mailing Telephone | 2486808000 |
| Mailing Fax Number | 2486808032 |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2016-08-25 |
| Authorized Official Name | JENNIFER JOHNSON (DIRECTOR, CENTRAL BILLING OFFICE) |
| Authorized Official Telephone | 2486808206 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WC0200X |
Registered Nurse Specialization: Critical Care Medicine |
Nursing Service Providers | ||
| N | 163WH1000X |
Registered Nurse Specialization: Hospice |
Nursing Service Providers | ||
| N | 163WM0102X |
Registered Nurse Specialization: Maternal Newborn |
Nursing Service Providers | ||
| Y | 163W00000X | Registered Nurse | Nursing Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | MI BLUE CROSS GROUP PIN # | 500F319040 | 01 |
| Other Name | Type Code |
|---|---|
| PH Nurse Practitioners/Providence Hospital and Medical Centers Inc | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295242824 | Providence-providence Park Hospital | Audiologist | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2018-01-04 |
| 1730144791 | Providence-providence Park Hospital | Orthopaedic Surgery | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2006-04-20 |
| 1467417428 | Providence-providence Park Hospital | Otolaryngology | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2006-04-20 |
| 1376508333 | Providence-providence Park Hospital | Physician Assistant | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2006-04-20 |
| 1649235615 | Providence-providence Park Hospital | Radiology | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2006-04-20 |
| 1922061167 | Providence-providence Park Hospital | Emergency Medicine | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2006-04-10 |
| Street Address |
16001 W 9 MILE RD PHYSICIAN BILLING SERVICES |
| 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 | 163W00000X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| (1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive either a diploma from a hospital program, an associate degree in nursing (A.D.N.) or a Bachelor of Science degree in nursing (B.S.N.), who is licensed or certified by the state, and is practicing within the scope of that license or certification. R.N.’s assist patient in recovering and maintaining their physical or mental health. They assist physicians during treatments and examinations and administer medications. (2) A provider who is trained and educated in a formal nursing education program at an accredited school of nursing, passes a national certification examination, and is licensed by the state to practice nursing. The individual provides nursing services to patients or clients in areas such as health promotion, disease prevention, acute and chronic care and restoration and maintenance of health across the life span. |
| Notes: Sources: (2) American Nurses Association, American Nurses Credentialing Center, 1996 Certification Catalogue, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033732672 | Carolyn Marie Demetriou | Registered Nurse | 2 Towne Sq, Southfield, MI 48076-3769 | 2020-05-18 |
| 1154955292 | Judy C Staples | Registered Nurse | 23800 West 10 Mile Road, Ste. 110, Southfield, MI 48033 | 2020-02-27 |
| 1811475593 | Terri L Miller | Registered Nurse | 29601 Stellamar Dr, Southfield, MI 48076-5212 | 2018-08-03 |
| 1053819763 | Tameka Littleton | Registered Nurse | 22750 Wrexford Dr, Southfield, MI 48033-6569 | 2018-01-28 |
| 1962918573 | Stacy Milburn | Registered Nurse | 25024 Friar Ln, Southfield, MI 48033-2712 | 2017-12-19 |
| 1932632643 | Macie Gater | Registered Nurse | 19666 Villa Ct E, Southfield, MI 48076-2435 | 2017-04-10 |
| 1093248916 | Cheryl Ann Cascio | Registered Nurse | 20755 Greenfield Road Suite 100, Southfield, MI 48075 | 2017-04-07 |
| 1487195012 | Nexts Care | Registered Nurse | 26400 Lahser Rd Suite 345, Southfield, MI 48033-2604 | 2017-03-15 |
| 1538618228 | Ebony Johnson | Registered Nurse | 25100 W 8 Mile Rd, Southfield, MI 48033-4024 | 2016-09-23 |
| 1003362252 | Mark Kline | Registered Nurse | 22170 W Nine Mile Rd, Southfield, MI 48033 | 2016-08-28 |
| Find all providers in SOUTHFIELD | ||||
| City | SOUTHFIELD |
| Zip Code | 48075 |
Please comment or provide details below to improve the information on PROVIDENCE-PROVIDENCE PARK HOSPITAL.
| 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.