NPIMap

Individual provider Active NPI

Ali H Haidar, M.D.

  • Pulmonary Disease Physician
  • Port Huron, MI
National Provider Identifier
1104892058
Registry record updated Dec 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
4301406466 Issued in MI
Practice address
1231 Pine Grove Ave
Suite 2B
Port Huron, MI 48060-3500
Phone
(810) 987-5500
Fax
(810) 987-6321
NPI assigned
Feb 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301406466 MI
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 4301406466 MI
Pulmonary Disease Physician 207RP1001X 4301406466 MI Primary

Addresses

Primary practice location

1231 Pine Grove Ave
Suite 2B
Port Huron, MI 48060-3500

Mailing address

1231 Pine Grove Ave Ste 2B
Port Huron, MI 48060-3500
Phone (810) 987-5500

Other identifiers 1

IdentifierTypeStateIssuer
1104892058MedicaidMI

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
I20100127000916 MI Practitioner - Pulmonary DiseasePractitioner - Internal MedicinePractitioner - Critical Care (Intensivists) 9234047929 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists), Internal Medicine
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McLaren Port HuronGroup PAC ID 9931018702, 48 clinicians

Practice addresses (Care Compare)

1231 Pine Grove Ave
Suite 2B
Port Huron, MI 48060-3500
Phone (810) 987-5500

Hospital & facility affiliations

  • McLaren Port Huron Hospital, Port Huron, MI, CCN 230216
  • McKenzie Health System Hospital, Sandusky, MI, CCN 231314
  • Lake Huron Medical Center Hospital, Port Huron, MI, CCN 230031
  • Ascension River District Hospital Hospital, East China, MI, CCN 230241
  • Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
McLaren Port Huron Internal Medicine Current Accepting new patients
McLaren Port Huron CurrentSince Jul 31, 2016 Accepting new patients

Locations

1221 Pine Grove Ave
Port Huron, MI 48060
Phone (810) 989-3300

1231 Pine Grove Ave
Ste 2B
Port Huron, MI 48060
Phone (810) 987-5500

1163 S Carney Dr
Saint Clair, MI 48079
Phone (810) 561-8450

Interoperability endpoints

  • Direct secure messaging: ahaidar484856@direct.hfhs.org
  • Direct secure messaging: ali.haidar.1@13601.direct.athenahealth.com

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 6

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": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545264000000",
    "number": "1104892058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1231 PINE GROVE AVE STE 2B",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603500",
            "telephone_number": "810-987-5500",
            "fax_number": "810-987-6321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1231 PINE GROVE AVE",
            "address_2": "SUITE 2B",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603500",
            "telephone_number": "810-987-5500",
            "fax_number": "810-987-6321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAIDAR",
        "first_name": "ALI",
        "middle_name": "H",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-28",
        "last_updated": "2018-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301406466",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "MI",
            "license": "4301406466",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MI",
            "license": "4301406466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104892058",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Huron, MI

Sources for this page

Verify at the official NPI Registry.