NPIMap

Organization Active NPI

Pathology Specialists of Southeast Michigan PC

  • Anatomic Pathology & Clinical Pathology Physician
  • Detroit, MI
National Provider Identifier
1023100500
Registry record updated Feb 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
403788 Issued in MI
Legal business name
PATHOLOGY SPECIALISTS OF SOUTHEAST MICHIGAN PC
Practice address
22101 Moross Rd
Detroit, MI 48236-2148
Phone
(800) 288-8325
Fax
(419) 866-5453
NPI assigned
Sep 29, 2006
Last updated
Feb 19, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2025

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

Authorized official

Name
Dr. Basim Al-Khafaji, MDNPI 1386758571
Title
President
Phone
(313) 343-3521

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 403788 MI Primary

Addresses

Primary practice location

22101 Moross Rd
Detroit, MI 48236-2148

Mailing address

PO Box 72572
Cleveland, OH 44192-0002
Phone (800) 288-8325

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040806000310 MI Part B Supplier - Clinic/Group Practice 6608848130 Receives reassigned benefits from 15 practitioners
Practice locations: Grosse Pointe Woods, MI; Detroit, MI
O20040806000435 MI Part B Supplier - Clinic/Group Practice 6608848130 Practice locations: Detroit, MI

National Provider Directory

National Provider Directory

Locations

19251 Mack Ave
Ste 80LL
Grosse Pointe Woods, MI 48236

Practitioners & affiliated clinicians

Practitioners 192

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.

View all 192

NPI Registry JSON

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739923200000",
    "number": "1023100500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 72572",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441920002",
            "telephone_number": "800-288-8325",
            "fax_number": "419-866-5453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22101 MOROSS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362148",
            "telephone_number": "800-288-8325",
            "fax_number": "419-866-5453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHOLOGY SPECIALISTS OF SOUTHEAST MICHIGAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A",
        "authorized_official_last_name": "AL-KHAFAJI",
        "authorized_official_first_name": "BASIM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-343-3521",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MI",
            "license": "403788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Feb 19, 2025; 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.