The Wellness Plan Medical Centers
Organization Active NPI Clinic/Center · Detroit, MI
NPI 1043373244 · NPPES record last updated Aug 13, 2020
Key facts
- NPI
- 1043373244
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- THE WELLNESS PLAN MEDICAL CENTERS
- Practice address
- 2888 W Grand Blvd
Detroit, MI 48202-2612 - Phone
- (313) 875-4200
- Fax
- (313) 875-5611
- NPI assigned
- Dec 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Anthony V. King
- Title
- Ceo and Exec Dir
- Phone
- (313) 202-8550
Owners & managing parties with NPI records 1
-
Margaret Betts, MD
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 3
Practitioners 64
-
Danita Mayes Dixon, FNP-C
-
Rhona A Fingal, M.D.
-
Sarah Kironde, N.P.
-
Sharon Miller, MD
-
Adijat Ogunyemi, SOCIAL WORKER
-
Necola Selena Table, FNP-C
-
Eboni T. Martin, M.D.
-
Ebazare Maria Ayewah, M.D.
-
Chaka Chipawe, NP-C
-
Pritha Chitagi, M.D.
-
Cecilia Cristina Cosma, M.D.
-
Lemica Symiria Cox, LMSW
-
Laura Jane Crandall, M.D.
-
Brittney Daftuar, LMSW
-
Konwre Gordon, FNP-BC
-
Arash Javanbakht, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (4 enrollments) in MI
Federally qualified health center certification: CCN 231927
- Legal name
- THE WELLNESS PLAN MEDICAL CENTERS
- Doing business as
- THE WELLNESS PLAN MEDICAL CENTERS
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- May 2, 2008
- Last certification
- May 2, 2008
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Nov 14, 1972 in MI
- Enrollment address
- 2888 W Grand Blvd
Detroit, MI 48202-2612
Federally qualified health center certification: CCN 231932
- Legal name
- THE WELLNESS PLAN MEDICAL CENTERS
- Doing business as
- THE WELLNESS PLAN MEDICAL CENTERS
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jul 22, 2008
- Last certification
- Jul 22, 2008
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Nov 14, 1972 in MI
- Enrollment address
- 4909 E Outer Dr
Detroit, MI 48234-3446
Federally qualified health center certification: CCN 231933
- Legal name
- THE WELLNESS PLAN MEDICAL CENTERS
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Aug 6, 2008
- Last certification
- Aug 6, 2008
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Nov 14, 1972 in MI
- Enrollment address
- 21040 Greenfield Rd
Oak Park, MI 48237-3025
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Anthony V King |
Corporate Officer |
Feb 12, 2007 | 100% |
| W-2 Managing Employee | Feb 12, 2007 | ||
| Daniell L Jones |
Corporate Director | Oct 18, 2010 | |
| Margaret L Betts |
Corporate Director | Dec 7, 2005 | |
| Mahasin N. Pierce |
Corporate Director | Jun 12, 2013 | |
| Cassandra Willis-Abner |
Corporate Director | Jan 9, 2013 | |
| Anita Moncrease |
Corporate Director | Dec 7, 2005 | |
| Adrian Lewis |
Corporate Director | Jan 9, 2013 | |
| Betty Shelton |
Corporate Director |
May 1, 2016 | |
| W-2 Managing Employee |
May 1, 2016 | ||
| Corporate Officer |
May 1, 2016 | 50% | |
| W-2 Managing Employee |
May 1, 2016 | 50% | |
| Larry Warren |
Corporate Director | May 14, 2014 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| The Wellness Plan Medical Center-Pontiac |
Federally qualified health center | Operational/Managerial Control (100%) | Jul 7, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040925000098 | MI | Part B Supplier - Clinic/Group Practice | 1052380201 |
Receives reassigned benefits from 46 practitioners 1 other NPI on this enrollment Practice locations: Detroit, MI; Oak Park, MI; Pontiac, MI |
| O20080306000639 | MI | Part a Provider - Federally Qualified Health Center (FQHC) | 1052380201 | Practice locations: Detroit, MI |
| O20080603000231 | MI | Part a Provider - Federally Qualified Health Center (FQHC) | 1052380201 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Detroit, MI |
| O20080619000341 | MI | Part a Provider - Federally Qualified Health Center (FQHC) | 1052380201 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Oak Park, MI |
National Provider Directory
Locations
2875 W Grand Blvd
Detroit, MI 48202
Phone (313) 875-4200
46156 Woodward Ave
#A
Pontiac, MI 48342
Phone (517) 214-6531
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/GCBDCD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | MI | Yes |
Addresses
Primary practice location
2888 W Grand Blvd
Detroit, MI 48202-2612
Mailing address
7700 2ND Ave
Detroit, MI 48202-2477
Phone (313) 202-8660
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 23-1927 | Other | MI | FQHC LOOK A LIKE |
Other names
- The Wellness Plan
- The Wellness Plan Medical Centers
Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.