Individual provider Active NPI

Mouna Bazzi, NURSE PRACTITIONER

  • Acute Care Nurse Practitioner
  • Dearborn, MI
National Provider Identifier
1073225678
Registry record updated Oct 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
4704327655 Issued in MI
Practice address
4700 Schaefer Rd Ste 260
Dearborn, MI 48126-3743
Phone
(947) 523-4650
NPI assigned
Dec 15, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 21, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 4704327655 MI Primary
Nurse Practitioner 363L00000X 4704327655 MI

Addresses

Primary practice location

4700 Schaefer Rd Ste 260
Dearborn, MI 48126-3743

Mailing address

26901 Beaumont Blvd Ste 3D
Southfield, MI 48033-3849

Other practice location 1

18101 Oakwood Blvd
Dearborn, MI 48124-4089
Phone (313) 593-7000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mbazzi1224923@epic00.shdirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221221002116 MI Practitioner - Nurse Practitioner 7416327150 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Wayne State University School of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University Physician GroupGroup PAC ID 8628087681, 399 clinicians

Practice addresses (Care Compare)

4201 Saint Antoine St
Detroit, MI 48201-2153
Phone (313) 745-3000

4700 Schaefer Rd
Suite 260
Dearborn, MI 48126-3743
Phone (947) 523-4650

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704327655MIMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Michigan Healthcare Professionals PC CurrentSince Aug 1, 2024 Accepting new patients
A Ahmad MD PLC CurrentSince Dec 20, 2022 Accepting new patients
Michigan Healthcare Professionals PC CurrentSince Aug 1, 2024 Accepting new patients
Beaumont Medical Group- Specialty Services CurrentSince Oct 20, 2025 Accepting new patients
University Physician Group CurrentSince Jul 1, 2023 Accepting new patients

Locations

4700 Schaefer Rd
Ste 260
Dearborn, MI 48126
Phone (313) 583-5400

18101 Oakwood Blvd
Dearborn, MI 48124
Phone (313) 593-8780

4201 Saint Antoine St
Detroit, MI 48201
Phone (313) 745-3615

6501 Greenfield Rd
Detroit, MI 48228
Phone (313) 281-2225

4100 John R St
Detroit, MI 48201
Phone (313) 576-8530

6071 W Outer Dr
Detroit, MI 48235
Phone (313) 966-3300

32255 Northwestern Hwy
Ste 150
Farmington Hills, MI 48334
Phone (248) 419-3456

27900 Grand River Ave
Ste 220
Farmington Hills, MI 48336
Phone (248) 477-0552

29992 Northwestern Hwy
Ste C
Farmington Hills, MI 48334
Phone (248) 851-1430

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

27301 Dequindre Rd
Ste 314
Madison Hts, MI 48071
Phone (248) 399-4400

1221 Pine Grove Ave
Port Huron, MI 48060
Phone (810) 989-3300

3577 W 13 Mile Rd
Ste 310
Royal Oak, MI 48073
Phone (248) 329-3060

26901 Beaumont Blvd
Ste 3D
Southfield, MI 48033
Phone (947) 522-1860

1560 E Maple Rd
Ste 200
Troy, MI 48083
Phone (248) 581-5200

Interoperability endpoints

  • Direct secure messaging: mbazzi1224923@epic00.shdirect.org

Organizations & group practices 5

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": "1671062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761004800000",
    "number": "1073225678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 SCHAEFER RD STE 260",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481263743",
            "telephone_number": "947-523-4650"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18101 Oakwood Blvd",
            "address_purpose": "LOCATION",
            "city": "Dearborn",
            "state": "MI",
            "postal_code": "481244089",
            "country_code": "US",
            "telephone_number": "313-593-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAZZI",
        "first_name": "MOUNA",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-12-15",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MI",
            "license": "4704327655",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704327655",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbazzi1224923@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "4700 Schaefer Rd Ste 260",
            "city": "Dearborn",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481263743",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.