NPIMap

Organization Active NPI

The Wellness Plan Medical Centers

Doing business as The Wellness Plan

  • Clinic/Center
  • Detroit, MI
National Provider Identifier
1043373244
Registry record updated Aug 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
THE WELLNESS PLAN MEDICAL CENTERS
Doing business as
The Wellness Plan
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
Last updated
Aug 13, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2020

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

Authorized official

Name
Mr. Anthony V. King
Title
Ceo and Exec Dir
Phone
(313) 202-8550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X MI Primary

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 names 2

  • The Wellness Plan Doing business as
  • The Wellness Plan Medical Centers Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1043373244. Details of each certification follow.

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
CorporationNon-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
CorporationNon-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
CorporationNon-profit
Incorporated
Nov 14, 1972 in MI
Enrollment address
21040 Greenfield Rd
Oak Park, MI 48237-3025

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

2875 W Grand Blvd
Detroit, MI 48202
Phone (313) 875-4200

21040 Greenfield Rd
Ste 200
Oak Park, MI 48237
Phone (248) 967-1888

46156 Woodward Ave
#A
Pontiac, MI 48342
Phone (517) 214-6531

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GCBDCD

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Anthony V King Individual Corporate OfficerCeo and Executive Director Feb 12, 2007 100%
W-2 Managing Employee Feb 12, 2007
Daniell L Jones Individual Corporate Director Oct 18, 2010
Margaret L Betts Individual Corporate Director Dec 7, 2005
Mahasin N. Pierce Individual Corporate Director Jun 12, 2013
Cassandra Willis-Abner Individual Corporate Director Jan 9, 2013
Anita Moncrease Individual Corporate Director Dec 7, 2005
Adrian Lewis Individual Corporate Director Jan 9, 2013
Betty Shelton Individual Corporate DirectorChief Administrative Officer May 1, 2016
W-2 Managing EmployeeChief Administrative Officer May 1, 2016
Corporate OfficerChief Administrative Officer May 1, 2016 50%
W-2 Managing EmployeeChief Administrative Officer May 1, 2016 50%
Larry Warren Individual Corporate Director May 14, 2014

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Wellness Plan Medical Center-PontiacPontiac, MI, CCN 231127 Federally qualified health center Operational/Managerial Control (100%) Jul 7, 2017

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 64

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 64

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597276800000",
    "number": "1043373244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7700 2ND AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022477",
            "telephone_number": "313-202-8660",
            "fax_number": "313-202-8653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2888 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022612",
            "telephone_number": "313-875-4200",
            "fax_number": "313-875-5611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WELLNESS PLAN MEDICAL CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "V.",
        "authorized_official_title_or_position": "CEO AND EXEC DIR",
        "authorized_official_telephone_number": "313-202-8550",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Wellness Plan",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Wellness Plan Medical Centers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Wellness Plan Medical Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.