NPIMap

Individual provider Active NPI

Raven Richardson, FNP

  • Family Nurse Practitioner
  • Hazel Park, MI
National Provider Identifier
1083375380
Registry record updated Jul 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704322492 Issued in MI
Practice address
624 E 9 Mile Rd
Hazel Park, MI 48030-1842
Phone
(248) 629-7497
NPI assigned
Jan 7, 2022
Last updated
Jul 20, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704322492 MI Primary

Addresses

Primary practice location

624 E 9 Mile Rd
Hazel Park, MI 48030-1842

Mailing address

624 E 9 Mile Rd
Hazel Park, MI 48030-1842

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
I20231212000246 MI Practitioner - Nurse Practitioner 9133578578 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Berkley Urgent Care PLLCGroup PAC ID 7315167632, 8 clinicians
Advance Health Urgent Care PLLCGroup PAC ID 7012432396, 4 clinicians

Practice addresses (Care Compare)

3270 Greenfield Rd
Berkley, MI 48072-1161
Phone (248) 268-1525

36454 Groesbeck Hwy
Clinton TWP, MI 48035-1548
Phone (586) 519-9116

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Berkley Urgent Care PLLC CurrentSince Jan 1, 2025 Accepting new patients
Dearborn Pain Center PLLC CurrentSince Feb 5, 2024 Accepting new patients
Express Health Urgent Care PLLC CurrentSince Jan 1, 2025 Accepting new patients
Hazel Park Primary Care LLC CurrentSince Feb 5, 2024 Accepting new patients
Signify Health Medical Associates, PLLC CurrentSince Nov 6, 2023 Accepting new patients

Locations

3270 Greenfield Rd
Berkley, MI 48072
Phone (248) 268-1525

624 E 9 Mile Rd
Hazel Park, MI 48030
Phone (248) 268-2566

624 E 9 Mile Rd
Ste B
Hazel Park, MI 48030
Phone (248) 629-7497

26400 Plymouth Rd
Redford, MI 48239
Phone (313) 543-3300

13 N Washington St
Ypsilanti, MI 48197
Phone (734) 329-4620

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DBGIDD/Endpoint/DBGIDD

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

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": "1641513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721433600000",
    "number": "1083375380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 E 9 MILE RD",
            "city": "HAZEL PARK",
            "state": "MI",
            "postal_code": "480301842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 E 9 MILE RD",
            "city": "HAZEL PARK",
            "state": "MI",
            "postal_code": "480301842",
            "telephone_number": "248-629-7497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "RAVEN",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-07",
        "last_updated": "2024-07-20",
        "certification_date": "2024-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704322492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hazel Park, MI

Sources for this page

Verify at the official NPI Registry.