MMG 1 PC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

MMG 1 PC

Practice address

28625 Northwestern Hwy
Suite 213
Southfield, MI 48034-1828

Phone

(248) 354-9666

Fax

(248) 354-3653

NPI assigned

Jul 19, 2006

Last updated

May 24, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Geoffrey A Trivax, MDNPI 1164407730

Title

President

Phone

(313) 538-3099

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs on the same Medicare enrollment 9

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

• MMG 1 PC

  dba Internal Medicine Specialists

  • Internal Medicine Physician
  • West Bloomfield, MI
  • NPI 1023043486

  O20031104000106

  Same enrollment
• MMG 1 PC

  dba Millenium Diagnostic Center

  • Internal Medicine Physician
  • Farmington Hills, MI
  • NPI 1912933540

  O20031104000106

  Same enrollment
• MMG 1 PC

  dba Internal Medicine Physicians

  • Internal Medicine Physician
  • Farmington Hills, MI
  • NPI 1982639357

  O20031104000106

  Same enrollment
• MMG 1PC

  dba Comprehensive Internists

  • Internal Medicine Physician
  • West Bloomfield, MI
  • NPI 1073548442

  O20031104000106

  Same enrollment
• MMG 1PC

  dba Internal Medicine Plus

  • Internal Medicine Physician
  • Bingham Farms, MI
  • NPI 1154356517

  O20031104000106

  Same enrollment
• MMG 1PC

  • Family Medicine Physician
  • West Bloomfield, MI
  • NPI 1205855186

  O20031104000106

  Same enrollment
• MMG 1PC

  • Internal Medicine Physician
  • Bingham Farms, MI
  • NPI 1225063688

  O20031104000106

  Same enrollment
• MMG 1PC

  dba Associated Rheumatology Consultants

  • Rheumatology Physician
  • Southfield, MI
  • NPI 1629184049

  O20031104000106

  Same enrollment
• MMG 1PC

  dba Premier Internists

  • Internal Medicine Physician
  • Southfield, MI
  • NPI 1679586192

  O20031104000106

  Same enrollment

Practitioners 1

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.

• Geoffrey Trivax, M.D.

  • Internal Medicine Physician
  • Southfield, MI
  • NPI 1164407730
  Authorized official Same address or phone

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621814400000",
    "number": "1023037025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29992 NORTHWESTERN HWY STE C",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483343292",
            "telephone_number": "248-851-1430",
            "fax_number": "248-851-5182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28625 NORTHWESTERN HWY",
            "address_2": "SUITE 213",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341828",
            "telephone_number": "248-354-9666",
            "fax_number": "248-354-3653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMG 1 PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A",
        "authorized_official_last_name": "TRIVAX",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-538-3099",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP",
            "identifier": "500F318990",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas A Mladsi, MD
• Theresa Mlinarcik
• MLK USA, LLC
• Christine Mlynarek, M.D.
• MM Medical Equipment,LLC
• MMG 1PC (Neurological Consultants)
• MMG 1PC
• MMG 1PC (Northwest Internal Medicine)
• MMG 1PC (Associated Rheumatology Consultants)
• MMG 1PC (Premier Internists)

• Nurse Practitioner in Southfield, MI
• Providers in Southfield, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; 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.