Individual provider Active NPI

Predrag Popovic, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • New York, NY
National Provider Identifier
1073550562
Registry record updated Jun 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
242475 Issued in NY
Practice address
5141 Broadway
New York, NY 10034-1159
Phone
(212) 932-5218
NPI assigned
Jun 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 4301064159 MI
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 242475 NY Primary

Addresses

Primary practice location

5141 Broadway
New York, NY 10034-1159

Mailing address

630 W 168TH St # 4
New York, NY 10032-3725

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, NY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060809000257 MI Practitioner - Geriatric MedicinePractitioner - Internal MedicinePractitioner - Hospice/Palliative Care 8325036924 Reassigns benefits to 1 organization
I20080828000522 NY Practitioner - Geriatric MedicinePractitioner - Internal MedicinePractitioner - Hospice/Palliative Care 8325036924 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Geriatric MedicineAlso: Hospice/Palliative Care
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 916-2600

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Pathology Current Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Oct 1, 2014 Accepting new patients
Henry Ford Health System Current Accepting new patients
Henr Y Ford Health System CurrentSince Mar 7, 2017 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Aug 1, 2008 Accepting new patients
Henry Ford Health System CurrentSince Mar 7, 2017 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Oct 1, 2014 Accepting new patients
Rehabilitation Institute of Michigan Past Accepting new patients
Trustees of Columbia University in the City of New York Physical Medicine & Rehabilitation Past Accepting new patients

Locations

19401 Hubbard Dr
Dearborn, MI 48126
Phone (313) 982-8100

7800 W Outer Dr
Detroit, MI 48235
Phone (313) 387-8800

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

159 Kercheval Ave
Grosse Pointe Farms, MI 48236
Phone (313) 640-1000

39450 W Twelve Mile Rd
Novi, MI 48377
Phone (248) 344-0710

3500 15 Mile Rd
Sterling Hts, MI 48310
Phone (586) 977-9300

630 W 168th St
#4
New York, NY 10032
Phone (212) 305-6387

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

5141 Broadway
New York, NY 10034
Phone (212) 932-4000

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
  • Direct secure messaging: ppopovic445217@direct.hfhs.org

Organizations & group practices 9

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": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1497571200000",
    "number": "1073550562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 W 168TH ST # 4",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5141 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100341159",
            "telephone_number": "212-932-5218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POPOVIC",
        "first_name": "PREDRAG",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2017-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "4301064159",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NY",
            "license": "242475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.