NPIMap

Organization Active NPI

Center for Physical Medicine & Rehabilitation PC

  • Specialist
  • Warren, MI
National Provider Identifier
1003993312
Registry record updated Mar 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
CENTER FOR PHYSICAL MEDICINE & REHABILITATION PC
Practice address
13850 E 12 Mile Rd
Warren, MI 48088-3730
Phone
(586) 552-4499
Fax
(586) 552-4878
NPI assigned
Nov 1, 2006
Reactivated
Sep 5, 2023
Last updated
Mar 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Daniel Ryan, M.D.NPI 1730195231
Title
Owner
Phone
(586) 552-4499

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X MI
Specialist 174400000X MI Primary

Addresses

Primary practice location

13850 E 12 Mile Rd
Warren, MI 48088-3730

Mailing address

13850 E 12 Mile Rd
Warren, MI 48088-3730
Phone (586) 552-4499

Other names 1

  • Team Wellness Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040323001725 MI Part B Supplier - Clinic/Group Practice 0143111658 Receives reassigned benefits from 15 practitioners
2 other NPIs on this enrollment
Practice locations: Warren, MI

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

50174 Schoenherr Rd
Ste B
Shelby Township, MI 48315
Phone (586) 251-0100

11900 E 12 Mile Rd
Ste 209
Warren, MI 48093
Phone (586) 552-2100

13850 E 12 Mile Rd
Ste 2A
Warren, MI 48088
Phone (586) 445-3945

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711411200000",
    "number": "1003993312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13850 E 12 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480883730",
            "telephone_number": "586-552-4499",
            "fax_number": "586-552-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13850 E 12 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480883730",
            "telephone_number": "586-552-4499",
            "fax_number": "586-552-4878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR PHYSICAL MEDICINE & REHABILITATION PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "deactivation_date": "2023-08-01",
        "reactivation_date": "2023-09-05",
        "status": "A",
        "authorized_official_last_name": "RYAN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "586-552-4499",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Team Wellness",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Team Wellness",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Warren, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.