NPIMap

Individual provider Active NPI

Jimmy Charbel Haouilou, M.D.

  • Vascular Surgery Physician
  • Roseville, MI
National Provider Identifier
1063676286
Registry record updated Jan 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
4301084691 Issued in MI
Practice address
25350 Kelly Rd
Roseville, MI 48066-5824
Phone
(586) 270-5100
Fax
(586) 270-5111
NPI assigned
Jul 16, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 15, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 4301084691 MI
Vascular Surgery Physician 2086S0129X 4301084691 MI Primary

Addresses

Primary practice location

25350 Kelly Rd
Roseville, MI 48066-5824

Mailing address

25350 Kelly Rd
Roseville, MI 48066-5824
Phone (586) 270-5100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110923000483 MI Practitioner - Vascular Surgery 0749451763 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Vascular Associates PLLCGroup PAC ID 0042430548, 4 clinicians

Practice addresses (Care Compare)

25350 Kelly Rd
Suite a
Roseville, MI 48066-5824
Phone (586) 270-5100

Hospital & facility affiliations

  • Compassus Home Health Home health agency, Warren, MI, CCN 237081
  • Henry Ford Health St John Hospital Hospital, Detroit, MI, CCN 230165
  • Beaumont Hospital - Grosse Pointe Hospital, Grosse Pointe, MI, CCN 230089
  • Henry Ford Health Warren Hospital Hospital, Warren, MI, CCN 230195
  • Ascension River District Hospital Hospital, East China, MI, CCN 230241
  • Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053

Merit-based Incentive Payment System (MIPS)

Final score
18.59 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
61.96

Merit-based Incentive Payment System (MIPS)

Final score
84.37 of 100Reported as group
Quality
66.73
Promoting interoperability
100
Improvement activities
40
Cost
70.98

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion1-10
Varicose vein removal66
Leg revascularization (restoring blood flow)38
Removal of tissue117
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301084691MIMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jawad a Shah MD PC CurrentSince Feb 1, 2026 Accepting new patients
Beaumont Medical Group- Specialty Services Surgery CurrentSince Jul 1, 2018 Accepting new patients
Jawad a Shah, MD PC CurrentSince Feb 1, 2026 Accepting new patients
Henry Ford Health St. John Hospital Past Accepting new patients

Locations

28100 Grand River Ave
Ste 301
Farmington Hills, MI 48336
Phone (947) 521-1320

4800 S Saginaw St
Ste 1800
Flint, MI 48507
Phone (810) 732-8336

4800 S Saginaw St
Flint, MI 48507
Phone (810) 275-9108

16815 E Jefferson Ave
Ste 240
Grosse Pointe, MI 48230
Phone (313) 473-4690

468 Cadieux Rd
Grosse Pt Wds, MI 48230
Phone (313) 343-1000

Interoperability endpoints

  • Direct secure messaging: premiervascularassociatespllc.jimmyhaouilou@128861.advancedmd-direct.com
  • Direct secure messaging: jhaouilou1237048@epic00.shdirect.org
  • Direct secure messaging: jhaouilou1131351@direct.hfhs.org

Organizations & group practices 4

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1216166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768435200000",
    "number": "1063676286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25350 KELLY RD",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480665824",
            "telephone_number": "586-270-5100",
            "fax_number": "586-270-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25350 KELLY RD",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480665824",
            "telephone_number": "586-270-5100",
            "fax_number": "586-270-5111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAOUILOU",
        "first_name": "JIMMY",
        "middle_name": "CHARBEL",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-16",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301084691",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MI",
            "license": "4301084691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MI

Sources for this page

Verify at the official NPI Registry.