NPIMap

Organization Active NPI

Advanced Cardiovascular Clinic PC

  • Clinic/Center
  • Flushing, MI
National Provider Identifier
1104067487
Registry record updated Sep 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
ADVANCED CARDIOVASCULAR CLINIC PC
Practice address
6122 W Pierson Rd
Unit 1
Flushing, MI 48433-3104
Phone
(810) 600-3399
Fax
(810) 600-3398
NPI assigned
Mar 16, 2009
Last updated
Sep 13, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2016

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

Authorized official

Name
Dr. Mohammad Luay Alkotob, MDNPI 1598792830
Title
President
Phone
(810) 600-3399

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

6122 W Pierson Rd
Unit 1
Flushing, MI 48433-3104

Mailing address

6122 W Pierson Rd
Unit 1
Flushing, MI 48433-3104
Phone (810) 600-3399

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090526000039 MI Part B Supplier - Clinic/Group Practice 7911056882 Receives reassigned benefits from 11 practitioners
Practice locations: Flint, MI; Flushing, MI

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Advanced Cardio Clinic PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5084 Villa Linde Pkwy
Flint, MI 48532
Phone (810) 733-6050

6122 W Pierson Rd
Flushing, MI 48433

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1237161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473724800000",
    "number": "1104067487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6122 W PIERSON RD",
            "address_2": "UNIT 1",
            "city": "FLUSHING",
            "state": "MI",
            "postal_code": "484333104",
            "telephone_number": "810-600-3399",
            "fax_number": "810-600-3398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6122 W PIERSON RD",
            "address_2": "UNIT 1",
            "city": "FLUSHING",
            "state": "MI",
            "postal_code": "484333104",
            "telephone_number": "810-600-3399",
            "fax_number": "810-600-3398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED CARDIOVASCULAR CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-16",
        "last_updated": "2016-09-13",
        "status": "A",
        "authorized_official_last_name": "ALKOTOB",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_middle_name": "LUAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "810-600-3399",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2016; 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.