Detroit Area Agency on Aging

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

DETROIT AREA AGENCY ON AGING

Practice address

1333 Brewery Park Blvd Ste 200
Detroit, MI 48207-4544

Phone

(313) 446-4444

Fax

(313) 446-4445

NPI assigned

Nov 13, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Ronald Taylor

Title

President & Ceo

Phone

(313) 446-4444

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Detroit Area Agency on Aging

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1134725427

  O20131121001566

  Same enrollment

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Anthony W Clarke, M.D.

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1811055858
  NPD
• Donnietra La'Verne Walls, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Jackson, MI
  • NPI 1710654744
  NPD
• Charlene Walton Windham

  • Gerontology Nurse Practitioner
  • Southfield, MI
  • NPI 1518336080
  NPD

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1104997121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 BREWERY PARK BLVD STE 200",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482074544",
            "telephone_number": "313-446-4444",
            "fax_number": "313-446-4445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 BREWERY PARK BLVD STE 200",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482074544",
            "telephone_number": "313-446-4444",
            "fax_number": "313-446-4445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DETROIT AREA AGENCY ON AGING",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2023-02-07",
        "certification_date": "2021-12-03",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "313-446-4444",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4509010",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4509511",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Detroit - Gratiot P.C.
• Detroit - Plymouth P.C,
• Detroit - Washington P.C.
• Detroit Anesthesia Services PLLC
• Detroit Area Agency on Aging
• Detroit Area Agency on Aging
• Detroit Association Partnerships
• Detroit Association Partnerships
• Detroit Beyond LLC
• Detroit Brain Institute PLLC

• Case Management Agency in Detroit, MI
• Providers in Detroit, MI by specialty
• Case Management Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; 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.