NPIMap

Individual provider Active NPI

Fatina Masri, MD

  • General Practice Physician
  • Dearborn, MI
National Provider Identifier
1013180322
Registry record updated Mar 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
FM053444 Issued in MI
Practice address
13530 Michigan Ave
Suite 150
Dearborn, MI 48126-3574
Phone
(313) 945-9800
Fax
(313) 945-9184
NPI assigned
Apr 8, 2008
Last updated
Mar 10, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Medicine Physician 207U00000X 4301053444 MI
General Practice Physician 208D00000X FM053444 MI Primary

Addresses

Primary practice location

13530 Michigan Ave
Suite 150
Dearborn, MI 48126-3574

Mailing address

13530 Michigan Ave Ste 400
Dearborn, MI 48126-3575
Phone (313) 945-9800

Other identifiers 2

IdentifierTypeStateIssuer
0808276302OtherMIBCBS IND
1013180322MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060503000774 MI Practitioner - OtolaryngologyPractitioner - General PracticePractitioner - Allergy/ImmunologyPractitioner - Plastic and Reconstructive SurgeryPractitioner - Nuclear Medicine 2860402948

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
FM053444MIMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Michigan Anesthesia Group PLLC CurrentSince Sep 1, 2016 Accepting new patients
Advanced Surgery Center LLC Current Accepting new patients
Michigan Sleep Lab PastSince Apr 1, 2010 Accepting new patients
Michigan Specialty Clinic PLLC PastSince Jul 1, 2010 Accepting new patients
Michigan Specialty Clinic PLLC PastSince Jul 1, 2010 Accepting new patients

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1207612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583798400000",
    "number": "1013180322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13530 MICHIGAN AVE STE 400",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481263575",
            "telephone_number": "313-945-9800",
            "fax_number": "313-945-9184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13530 MICHIGAN AVE",
            "address_2": "SUITE 150",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481263574",
            "telephone_number": "313-945-9800",
            "fax_number": "313-945-9184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASRI",
        "first_name": "FATINA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-08",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": "MI",
            "license": "4301053444",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "FM053444",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS IND",
            "identifier": "0808276302",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013180322",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.