Individual provider Active NPI

Paul K Fozo, MD

  • Hospitalist Physician
  • Shelby Township, MI
National Provider Identifier
1073593174
Registry record updated May 26, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
4301080819 Issued in MI
Practice address
50505 Schoenherr Rd
Suite 340
Shelby Township, MI 48315-3140
Phone
(586) 731-8400
Fax
(586) 731-8406
NPI assigned
Jan 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301080819 MI
Hospitalist Physician 208M00000X 4301080819 MI Primary

Addresses

Primary practice location

50505 Schoenherr Rd
Suite 340
Shelby Township, MI 48315-3140

Mailing address

1746 Momentum PL
Chicago, IL 60689-5317
Phone (586) 731-8400

Other identifiers 3

IdentifierTypeStateIssuer
0827486OtherMIBCBS
474607010MedicaidMI
1073593174OtherMINPI

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050729000594 MI Practitioner - Internal Medicine 1355379504 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Health St. John HospitalGroup PAC ID 3173424082, 332 clinicians

Practice addresses (Care Compare)

19251 Mack Ave
Suite 333
Grosse Pointe Woods, MI 48236-2898
Phone (313) 343-7280

22101 Moross Rd
Detroit, MI 48236-2148
Phone (586) 753-0011

22201 Moross Rd
Detroit, MI 48236-2166

Hospital & facility affiliations

  • Henry Ford Health St John Hospital Hospital, Detroit, MI, CCN 230165
  • Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pathology Specialists of Southeast Michigan PC Current Accepting new patients
Henry Ford Health St. John Hospital CurrentSince Jan 10, 2011 Accepting new patients
Henry Ford Health St. John Hospital Internal Medicine CurrentSince Jan 10, 2011 Accepting new patients
Henry Ford Health St. John Hospital Current Accepting new patients
St. John Hospital Past Accepting new patients
Great Lakes Medicine, PLC Internal Medicine Past Accepting new patients

Locations

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

19251 Mack Ave
Ste 333
Grosse Pointe Woods, MI 48236
Phone (313) 343-7280

22201 Moross Rd
Ste 50
Grosse Pointe Woods, MI 48236
Phone (313) 343-7774

28000 Dequindre Rd
Warren, MI 48092
Phone (586) 743-0944

Interoperability endpoints

  • Direct secure messaging: pfozo1127132@direct.hfhs.org

Organizations & group practices 6

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 2

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": "1137456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274832000000",
    "number": "1073593174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1746 MOMENTUM PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606895317",
            "telephone_number": "586-731-8400",
            "fax_number": "586-731-8406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50505 SCHOENHERR RD",
            "address_2": "SUITE 340",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483153140",
            "telephone_number": "586-731-8400",
            "fax_number": "586-731-8406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOZO",
        "first_name": "PAUL",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-17",
        "last_updated": "2010-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301080819",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MI",
            "license": "4301080819",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0827486",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "474607010",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1073593174",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby Township, MI

Sources for this page

Verify at the official NPI Registry.