NPIMap

Organization Active NPI

University Pediatricians

  • Psychologist
  • Detroit, MI
National Provider Identifier
1124265335
Registry record updated Dec 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
UNIVERSITY PEDIATRICIANS
Practice address
3901 Beaubien St
Detroit, MI 48201-2119
Phone
(313) 966-5051
Fax
(313) 966-6618
NPI assigned
Jan 9, 2009
Reactivated
Dec 8, 2022
Last updated
Dec 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2022

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

Authorized official

Name
Ms. Yolanda Brown
Title
Provider Services Representative
Phone
(313) 966-5051

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X Primary

Addresses

Primary practice location

3901 Beaubien St
Detroit, MI 48201-2119

Mailing address

4201 Saint Antoine St
University Health Center 6F Mailbox #226
Detroit, MI 48201-2153
Phone (313) 966-5051

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040115000125 MI Part B Supplier - Clinic/Group Practice 9638070568 Receives reassigned benefits from 370 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Troy, MI; Detroit, MI

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Locations

3901 Beaubien St
Detroit, MI 48201
Phone (313) 745-5227

4201 Saint Antoine St
#6F
Detroit, MI 48201
Phone (313) 745-7329

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1231459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670457600000",
    "number": "1124265335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 SAINT ANTOINE ST",
            "address_2": "UNIVERSITY HEALTH CENTER 6F MAILBOX #226",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012153",
            "telephone_number": "313-966-5051",
            "fax_number": "313-966-6618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 BEAUBIEN ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012119",
            "telephone_number": "313-966-5051",
            "fax_number": "313-966-6618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY PEDIATRICIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-09",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "deactivation_date": "2022-10-25",
        "reactivation_date": "2022-12-08",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "YOLANDA",
        "authorized_official_title_or_position": "PROVIDER SERVICES REPRESENTATIVE",
        "authorized_official_telephone_number": "313-966-5051",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; 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.