ST JOHN HOSPITAL CORPORATION (NPI# 1811068760) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811068760 |
| Entity Type | Organization |
| Organization Name | ST JOHN HOSPITAL CORPORATION |
| Other Organization Name | SJH PHYSICIAN ASSISTANT GROUP |
| Practice Address |
22101 Moross Rd Detroit MI 48236-2148 |
| Mailing Address |
43800 Garfield Rd Ste 200 Clinton Township MI 48038-1136 |
| Practice Telephone | 5862284635 |
| Practice Fax Number | 5862284520 |
| Mailing Telephone | 5862284635 |
| Mailing Fax Number | 5862284520 |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2007-10-12 |
| Authorized Official Name | SANDRA E WHITMAN (DIRECTOR, PHYSICIAN BILLING SERVICE) |
| Authorized Official Telephone | 2487465822 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| SJH Physician Assistant Group | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720111701 | St John Hospital Corporation | Dietitian, Registered | 22101 Moross Rd, Detroit, MI 48236-2148 | 2007-03-13 |
| 1225136906 | St John Hospital Corporation | Ophthalmology | 22101 Moross Rd, Detroit, MI 48236-2148 | 2006-09-20 |
| 1598713414 | St John Hospital Corporation | Surgery | 22101 Moross Rd, Detroit, MI 48236-2148 | 2006-05-04 |
| 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 |
| 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 | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619583994 | Isabella Lapuz Dela Cruz | Physician Assistant | 18463 Livernois Ave, Detroit, MI 48221-2254 | 2020-09-22 |
| 1932750684 | Patrick D Wharton | Physician Assistant | 5053 Commonwealth St # 1s, Detroit, MI 48208-2039 | 2019-09-24 |
| 1942869300 | Laura Dorothy Konsitzke | Physician Assistant | 22201 Moross Rd Ste 380, Detroit, MI 48236-2176 | 2019-06-10 |
| 1619419553 | Erica Ellen Schweitzer | Physician Assistant | 4701 Saint Antoine St Ste E-510, Detroit, MI 48201-1428 | 2016-11-09 |
| 1992167027 | Heather Michelle Sutton | Physician Assistant | 3901 Beaubien Drive, Detroit, MI 48201 | 2016-03-28 |
| 1659769107 | Zhi Li | Physician Assistant | 22201 Moross Rd Ste 370, Detroit, MI 48236 | 2015-01-07 |
| 1619371564 | Charlene Sharon Staff | Physician Assistant | 17701 Warwick St, Detroit, MI 48219-4210 | 2014-10-21 |
| 1245646025 | Sara Gibrael | Physician Assistant | 259 Mack Ave # 2590, Detroit, MI 48201-2427 | 2014-07-01 |
| 1497076434 | Mary Beth Morse | Physician Assistant | 4201 St. Antoine - Uhc 5d #226, University Pediatricians, Detroit, MI 48201-2153 | 2010-06-14 |
| 1265550487 | Claudine Lilla | Physician Assistant | 6071 W Outer Dr Dept Of, Detroit, MI 48235-2624 | 2007-03-26 |
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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.