Organization Active NPI

Ultimate Medical Care PLC

  • Family Medicine Physician
  • Southfield, MI
National Provider Identifier
1063120244
Registry record updated May 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ULTIMATE MEDICAL CARE PLC
Practice address
20755 Greenfield Rd Ste 100
Southfield, MI 48075-5400
Phone
(947) 282-5009
Fax
(248) 809-2319
NPI assigned
Nov 7, 2022
Last updated
May 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2023

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

Authorized official

Name
Derrick Williamson, DONPI 1215922059
Title
Physician/Owner
Phone
(947) 282-5009

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
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

20755 Greenfield Rd Ste 100
Southfield, MI 48075-5400

Mailing address

23031 Wrexford Dr
Southfield, MI 48033-6575
Phone (248) 417-9822

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230411002017 MI Part B Supplier - Clinic/Group Practice 8123493806 Receives reassigned benefits from 2 practitioners
Practice locations: Dearborn, MI

National Provider Directory

National Provider Directory

Locations

20755 Greenfield Rd
Ste 802P
Southfield, MI 48075
Phone (248) 864-8618

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1667779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684713600000",
    "number": "1063120244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23031 WREXFORD DR",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480336575",
            "telephone_number": "248-417-9822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20755 GREENFIELD RD STE 100",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480755400",
            "telephone_number": "947-282-5009",
            "fax_number": "248-809-2319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ULTIMATE MEDICAL CARE PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-07",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A",
        "authorized_official_last_name": "WILLIAMSON",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "947-282-5009",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "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 May 22, 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.