NPIMap

Organization Active NPI

Livewell Medical Group PLLC

  • Internal Medicine Physician
  • Hamtramck, MI
National Provider Identifier
1043096688
Registry record updated Sep 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LIVEWELL MEDICAL GROUP PLLC
Practice address
3611 Carpenter St Ste 5
Hamtramck, MI 48212-2784
Phone
(313) 733-8286
Fax
(313) 826-0899
NPI assigned
Sep 7, 2023
Last updated
Sep 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2023

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

Authorized official

Name
Diana El Masri
Title
Billing Manager
Phone
(248) 215-0048

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

3611 Carpenter St Ste 5
Hamtramck, MI 48212-2784

Mailing address

3611 Carpenter St Ste 5
Hamtramck, MI 48212-2784
Phone (313) 733-8286

Other practice location 1

24831 Ryan Rd
Warren, MI 48091-3390
Phone (586) 619-7689

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231104000501 MI Part B Supplier - Clinic/Group Practice 0042667529 Receives reassigned benefits from 16 practitioners
Practice locations: Westland, MI; Warren, MI; Hamtramck, MI

National Provider Directory

National Provider Directory

Locations

1535 E State Fair
Ste 1
Highland Park, MI 48203

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1694044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695686400000",
    "number": "1043096688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3611 CARPENTER ST STE 5",
            "city": "HAMTRAMCK",
            "state": "MI",
            "postal_code": "482122784",
            "telephone_number": "313-733-8286",
            "fax_number": "313-826-0899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3611 CARPENTER ST STE 5",
            "city": "HAMTRAMCK",
            "state": "MI",
            "postal_code": "482122784",
            "telephone_number": "313-733-8286",
            "fax_number": "313-826-0899"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24831 Ryan Rd",
            "address_purpose": "LOCATION",
            "city": "Warren",
            "state": "MI",
            "postal_code": "480913390",
            "country_code": "US",
            "telephone_number": "586-619-7689",
            "fax_number": "586-619-7613",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIVEWELL MEDICAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-07",
        "last_updated": "2023-09-26",
        "certification_date": "2023-09-26",
        "status": "A",
        "authorized_official_last_name": "EL MASRI",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "248-215-0048"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hamtramck, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.