NPIMap

Organization Active NPI

Barbara Ann Karmanos Cancer Hospital

  • Community/Retail Pharmacy
  • Detroit, MI
National Provider Identifier
1013319201
Registry record updated Apr 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301010464 Issued in MI
Legal business name
BARBARA ANN KARMANOS CANCER HOSPITAL
Practice address
4100 John R St
Suite Hp00Rx
Detroit, MI 48201-2013
Phone
(313) 576-9350
Fax
(313) 576-9353
NPI assigned
Sep 19, 2014
Organization subpart
Yes
Parent organization
BARBARA ANN KARMANOS CANCER HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 20, 2023

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

Authorized official

Name
Brian Gamble
Title
Cfo
Phone
(313) 576-8935

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X 5301010464 MI Primary

Addresses

Primary practice location

4100 John R St
Suite Hp00Rx
Detroit, MI 48201-2013

Mailing address

4100 John R St
Suite Hp00Rx
Detroit, MI 48201-2013
Phone (313) 576-9350

Other names 1

  • Karmanos Cancer Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201029001939 MI Part B Supplier - Mass Immunization (Roster Biller Only) 6800844499 Practice locations: Detroit, MI

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Barbara Ann Hospital

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

4100 John R St
Ste HP0RX
Detroit, MI 48201
Phone (313) 576-9350

NPI Registry JSON

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

{
    "created_epoch": "1411084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681948800000",
    "number": "1013319201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 JOHN R ST",
            "address_2": "SUITE HP00RX",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012013",
            "telephone_number": "313-576-9350",
            "fax_number": "313-576-9353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 JOHN R ST",
            "address_2": "SUITE HP00RX",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012013",
            "telephone_number": "313-576-9350",
            "fax_number": "313-576-9353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BARBARA ANN KARMANOS CANCER HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BARBARA ANN KARMANOS CANCER HOSPITAL",
        "enumeration_date": "2014-09-19",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A",
        "authorized_official_last_name": "GAMBLE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "313-576-8935"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301010464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Karmanos Cancer Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2023; 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.