NPIMap

Organization Active NPI

Acadian Clinic PLLC

  • Internal Medicine Physician
  • Allen Park, MI
National Provider Identifier
1083119705
Registry record updated Jul 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ACADIAN CLINIC PLLC
Practice address
14726 Champaign Rd
Allen Park, MI 48101
Phone
(313) 789-7966
Fax
(313) 789-7970
NPI assigned
Mar 26, 2018
Last updated
Jul 1, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2018

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

Authorized official

Name
Diana El Masri
Title
Billing Manager
Phone
(201) 931-5713

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

14726 Champaign Rd
Allen Park, MI 48101

Mailing address

30700 Telegraph Rd Ste 1536
Bingham Farms, MI 48025-4590
Phone (248) 215-0048

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190130002926 MI Part B Supplier - Clinic/Group Practice 1355688235 Receives reassigned benefits from 5 practitioners
Practice locations: Allen Park, MI; Dearborn, MI; Detroit, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1522022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530403200000",
    "number": "1083119705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30700 TELEGRAPH RD STE 1536",
            "city": "BINGHAM FARMS",
            "state": "MI",
            "postal_code": "480254590",
            "telephone_number": "248-215-0048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14726 CHAMPAIGN RD",
            "city": "ALLEN PARK",
            "state": "MI",
            "postal_code": "48101",
            "telephone_number": "313-789-7966",
            "fax_number": "313-789-7970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACADIAN CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-26",
        "last_updated": "2018-07-01",
        "status": "A",
        "authorized_official_last_name": "EL MASRI",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "201-931-5713"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Allen Park, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2018; 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.