NPIMap

Organization Active NPI

Henry Ford Macomb Hospital Corporation

Doing business as Henry Ford Health System

  • Physician Assistant
  • Clinton TWP, MI
National Provider Identifier
1124421888
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Legal business name
HENRY FORD MACOMB HOSPITAL CORPORATION
Doing business as
Henry Ford Health System
Practice address
15855 19 Mile Rd
Clinton TWP, MI 48038-3504
Phone
(800) 532-2411
NPI assigned
Oct 8, 2014
Last updated
Sep 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Authorized official

Name
Ms. Shannon Phillips
Title
Enrollment
Phone
(313) 874-2892

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

15855 19 Mile Rd
Clinton TWP, MI 48038-3504

Mailing address

15855 19 Mile Rd
Clinton TWP, MI 48038-3504
Phone (800) 532-2411

Other names 1

  • HENRY FORD HEALTH SYSTEM Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040119000142 MI Part B Supplier - Clinic/Group Practice 7911808381 Receives reassigned benefits from 662 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Macomb, MI; Mount Clemens, MI; Richmond, MI; Romeo, MI; Shelby Township, MI; Clinton Township, MI; Sterling Heights, MI; Warren, MI…

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory

Locations

30795 23 Mile Rd
Ste 209
Chesterfield, MI 48047
Phone (586) 421-6000

Practitioners & affiliated clinicians

Practitioners 67

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 67

NPI Registry JSON

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

{
    "created_epoch": "1412726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726531200000",
    "number": "1124421888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15855 19 MILE RD",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480383504",
            "telephone_number": "800-532-2411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15855 19 MILE RD",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480383504",
            "telephone_number": "800-532-2411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENRY FORD MACOMB HOSPITAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-08",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "ENROLLMENT",
        "authorized_official_telephone_number": "313-874-2892",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HENRY FORD HEALTH SYSTEM",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clinton TWP, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; 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.