Individual provider Active NPI

Momal Tara Chand

  • Anatomic Pathology & Clinical Pathology Physician
  • Philadelphia, PA
National Provider Identifier
1104303148
Registry record updated Jun 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
4301114553 Issued in MI
Practice address
3400 Spruce St
Philadelphia, PA 19104-4238
Phone
(800) 789-7366
NPI assigned
Jul 23, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 4301114553 MI Primary

Addresses

Primary practice location

3400 Spruce St
Philadelphia, PA 19104-4238

Mailing address

3400 Spruce St
Philadelphia, PA 19104-4238

Other practice location 1

22101 Moross Rd
Detroit, MI 48236-2172
Phone (313) 343-3864

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
I20240213004388 MI Practitioner - Pathology 5698119006 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Physician GroupGroup PAC ID 8628087681, 399 clinicians

Practice addresses (Care Compare)

3990 John R St
Detroit, MI 48201-2018
Phone (313) 745-8040

Hospital & facility affiliations

  • Karmanos Cancer Center Hospital, Detroit, MI, CCN 230297
  • Detroit Receiving Hospital Hospital, Detroit, MI, CCN 230273
  • Harper University Hospital Hospital, Detroit, MI, CCN 230104
  • Huron Valley-Sinai Hospital Hospital, Commerce Township, MI, CCN 230277
  • Sinai-Grace Hospital Hospital, Detroit, MI, CCN 230024

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301114553MIMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Physician Group Anatomic Pathology & Clinical Pathology CurrentSince Feb 1, 2024 Accepting new patients
University Physician Group Past Accepting new patients

Locations

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

4100 John R St
Detroit, MI 48201
Phone (313) 576-8530

3990 John R St
Detroit, MI 48201
Phone (313) 745-6211

400 Mack Ave
Detroit, MI 48201
Phone (313) 448-9006

1560 E Maple Rd
Ste 200
Troy, MI 48083
Phone (248) 581-5200

Organizations & group practices 2

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 5

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": "1532304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655337600000",
    "number": "1104303148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044238",
            "telephone_number": "800-789-7366"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22101 Moross Rd",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482362172",
            "country_code": "US",
            "telephone_number": "313-343-3864",
            "fax_number": "313-881-4727",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAND",
        "first_name": "MOMAL",
        "middle_name": "TARA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-23",
        "last_updated": "2022-06-16",
        "certification_date": "2022-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MI",
            "license": "4301114553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.