NPIMap

Organization Active NPI

Oakland Integrated Healthcare Network

Doing business as Plum Hollow Center

  • Federally Qualified Health Center (FQHC)
  • Southfield, MI
National Provider Identifier
1083965065
Registry record updated Jun 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OAKLAND INTEGRATED HEALTHCARE NETWORK
Doing business as
Plum Hollow Center
Practice address
22200 W. Nine Mile Rd
Southfield, MI 48033-6008
Phone
(248) 724-7600
NPI assigned
Oct 1, 2012
Organization subpart
Yes
Parent organization
OAKLAND INTEGRATED HEALTHCARE NETWORKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 1, 2016

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

Authorized official

Name
Mrs. Debra Brinson
Title
Ceo
Phone
(248) 724-7438

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X MI Primary

Addresses

Primary practice location

22200 W. Nine Mile Rd
Southfield, MI 48033-6008

Mailing address

P.O. Box 430150
Pontiac, MI 48343
Phone (248) 724-7600

Other names 1

  • Plum Hollow Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120611000523 MI Part B Supplier - Clinic/Group Practice 9436313004 Receives reassigned benefits from 47 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pontiac, MI; Waterford, MI; Southfield, MI
O20160308002318 MI Part A Provider - Federally Qualified Health Center (FQHC) 9436313004 Practice locations: Southfield, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083965065. Details of each certification follow.

Federally qualified health center certification: CCN 231088

Legal name
OAKLAND INTEGRATED HEALTHCARE NETWORK
Doing business as
PLUM HOLLOW CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 4, 2016
Last certification
Feb 4, 2016
Ownership / control type
For profit – corporation
Organization structure
LLCNon-profit
Incorporated
May 20, 2011 in MI
Enrollment address
22200 W 9 Mile Rd
Southfield, MI 48033-6008

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Oakland Integrated Network

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Melissa M McQueen Individual W-2 Managing EmployeeRevenue Cycle Manager Jun 12, 2017
Debra Brinson Individual Corporate OfficerCeo Jan 1, 2014
W-2 Managing EmployeeCeo Jan 1, 2014

Practitioners & affiliated clinicians

Practitioners 1

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": "1349049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464739200000",
    "number": "1083965065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 430150",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "48343",
            "telephone_number": "248-724-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22200 W. NINE MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480336008",
            "telephone_number": "248-724-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAKLAND INTEGRATED HEALTHCARE NETWORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OAKLAND INTEGRATED HEALTHCARE NETWORK",
        "enumeration_date": "2012-10-01",
        "last_updated": "2016-06-01",
        "status": "A",
        "authorized_official_last_name": "BRINSON",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "248-724-7438",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Plum Hollow Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.