NPIMap

Organization Active NPI

Fadi Salloum MD PC

Doing business as Impact

  • Internal Medicine Physician
  • Pontiac, MI
National Provider Identifier
1053510446
Registry record updated Aug 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301065435 Issued in MI
Legal business name
FADI SALLOUM MD PC
Doing business as
Impact
Practice address
50 N Perry St
Pontiac, MI 48342-2217
Phone
(248) 338-5516
Fax
(248) 338-5547
NPI assigned
Jul 16, 2007
Last updated
Aug 7, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2013

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

Authorized official

Name
Dr. Fadi Salloum, MDNPI 1205874831
Title
Owner
Phone
(248) 267-0135

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
Internal Medicine Physician 207R00000X 4301065435 MI Primary

Addresses

Primary practice location

50 N Perry St
Pontiac, MI 48342-2217

Mailing address

PO Box 869
Bloomfield Hills, MI 48303-0869
Phone (248) 267-0135

Other identifiers 1

IdentifierTypeStateIssuer
OP46550OtherMIMEDICARE GROUP #

Other names 1

  • IMPACT Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070813000088 MI Part B Supplier - Clinic/Group Practice 2062503584 Receives reassigned benefits from 72 practitioners
Practice locations: White Lake, MI; Waterford, MI; Rochester Hills, MI; Rochester, MI; Pontiac, MI; Milford, MI; Bloomfield Hills, MI; Clarkston, MI…

National Provider Directory

National Provider Directory

Locations

5480 Parview Dr
Clarkston, MI 48346
Phone (248) 620-2420

1699 Cass Lake Rd
Ste 300
Keego Harbor, MI 48320

585 E Flint St
Lake Orion, MI 48362
Phone (248) 693-0505

1200 N Telegraph Rd
Ste 32E
Pontiac, MI 48341
Phone (248) 456-1991

Practitioners & affiliated clinicians

Practitioners 76

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 76

NPI Registry JSON

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

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375833600000",
    "number": "1053510446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 869",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483030869",
            "telephone_number": "248-267-0135",
            "fax_number": "248-338-5547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 N PERRY ST",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483422217",
            "telephone_number": "248-338-5516",
            "fax_number": "248-338-5547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FADI SALLOUM MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-16",
        "last_updated": "2013-08-07",
        "status": "A",
        "authorized_official_last_name": "SALLOUM",
        "authorized_official_first_name": "FADI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-267-0135",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301065435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP #",
            "identifier": "OP46550",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IMPACT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pontiac, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2013; 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.