MICHIGAN SPORTS AND SPINE CENTER PC – Physical Medicine & Rehabilitation Physician, NPI 1205887262
Physical Medicine & Rehabilitation Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MICHIGAN SPORTS AND SPINE CENTER PC
18312 MIDDLEBELT RD
LIVONIA, MI 481525007
Phone: (248) 429-9940
Type: Mailing
3937, Laplaya Lane, La Playa, Orchard Lake Village, Oakland County, Michigan, 48324, United States
ORCHARD LAKE, MI 483242965
Phone:
Type: Mailing
Troy Sports Center, 1819, East Big Beaver Road, Troy, Oakland County, Michigan, 48083, United States
SUITE 210
TROY, MI 480832015
Phone: (248) 680-9000
Fax: (248) 680-2929
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-11-04
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Revalidation due soon
Earliest CMS due date is 2026-07-31 (49 days away).
Enrollment records
1
Earliest due date
2026-07-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20041104000371 | O | Clinic/Group Practice | MI | 2026-07-31 |
What to do next
- Confirm the due date on the CMS Revalidation Lookup Tool.
- Complete revalidation in PECOS before the published due date.
- If you have multiple enrollment records, revalidate each one on its own schedule.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 48152)
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