Prime Medical Health Care PC

Key facts

NPI

1023075744

Entity type

Organization (NPI type 2)

Primary specialty

Family Medicine Physician 207Q00000X

License

0776377 (MI)

Legal business name

PRIME MEDICAL HEALTH CARE PC

Practice address

16184 E 10 Mile Rd Ste 101
Eastpointe, MI 48021

Phone

(586) 779-4550

Fax

(586) 779-4551

NPI assigned

Apr 27, 2006

Organization subpart

No

Authorized official

Name

Dr. Nwanneka Uchenna Odumodu, M.D. NPI 1619934320

Title

President

Phone

(734) 276-7239

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nwanneka U. Odumodu, M.D. Family Medicine Physician · Eastpointe, MI · NPI 1619934320
  Medicare reassignment NPD Authorized official FAMILY MEDICINE · MI

Medicare participation

Medicare fee-for-service enrollment

Enrolled in MI

Medicare enrollment records

National Provider Directory

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/17175/brand/1/csg/1/fhir/r4

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 22, 2018.

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526947200000",
    "number": "1023075744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1948 HARLEY CT",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481038980",
            "telephone_number": "734-276-7239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16184 E 10 MILE RD STE 101",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "48021",
            "telephone_number": "586-779-4550",
            "fax_number": "586-779-4551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME MEDICAL HEALTH CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-27",
        "last_updated": "2018-05-22",
        "status": "A",
        "authorized_official_last_name": "ODUMODU",
        "authorized_official_first_name": "NWANNEKA",
        "authorized_official_middle_name": "UCHENNA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "734-276-7239",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "0776377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Eastpointe, MI · Family Medicine Physician in Michigan