Active NPI
Andre Ellison
- Private Vehicle
- Southfield, MI
National Provider Identifier
1043755523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Private Vehicle
- Practice address
- 5000 Town Ctr
2405
Southfield, MI 48075-1110 - Phone
- (248) 943-4107
- NPI assigned
- Dec 20, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Private Vehicle | 347C00000X | Primary |
Addresses
Primary practice location
5000 Town Ctr
2405
Southfield, MI 48075-1110
Mailing address
5000 Town Ctr
2405
Southfield, MI 48075-1110
Phone (248) 943-4107
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mainstream Media Group | Private Vehicle | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1482192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1482192000000",
"number": "1043755523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5000 TOWN CTR",
"address_2": "2405",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480751110",
"telephone_number": "248-943-4107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5000 TOWN CTR",
"address_2": "2405",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480751110",
"telephone_number": "248-943-4107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLISON",
"first_name": "ANDRE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-12-20",
"last_updated": "2016-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "347C00000X",
"taxonomy_group": "",
"desc": "Private Vehicle",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.