MMG 1 PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

MMG 1 PC

Doing business as

Internal Medicine Specialists

Practice address

5821 W Maple Rd
Suite 190
West Bloomfield, MI 48322-2275

Phone

(248) 855-0407

Fax

(248) 855-1323

NPI assigned

Jul 12, 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, MD

Title

President

Phone

(313) 538-3099

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• INTERNAL MEDICINE SPECIALISTS Doing business as

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

  • Nurse Practitioner
  • Southfield, MI
  • NPI 1023037025

  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

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621814400000",
    "number": "1023043486",
    "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": "5821 W MAPLE RD",
            "address_2": "SUITE 190",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483222275",
            "telephone_number": "248-855-0407",
            "fax_number": "248-855-1323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMG 1 PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "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": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP",
            "identifier": "110F375900",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID TYPE UNSPECIFIED",
            "identifier": "CG6179",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INTERNAL MEDICINE SPECIALISTS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "INTERNAL MEDICINE SPECIALISTS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mitchell S. Wayne, DPM, PC
• Austin Mitchell
• Lashanta Ericka Mitchell
• Lawrence C. Mitchell, M.D.
• Marla Mitchell, LLMSW
• MMG 1PC (Comprehensive Internists)
• MMG 1PC
• MMS Northern Detroit, Inc (Majors Medical Supply)
• Hadley Merritt Moak
• Mobile Physicians Association PC

• Internal Medicine Physician in West Bloomfield, MI
• Providers in West Bloomfield, MI by specialty
• Internal Medicine Physician 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.