Organization Active NPI

West Dearborn Urgent Care PLLC

  • Urgent Care Clinic/Center
  • Dearborn, MI
National Provider Identifier
1124788666
Registry record updated May 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
WEST DEARBORN URGENT CARE PLLC
Practice address
2421 Monroe St Ste 102
Dearborn, MI 48124-3043
Phone
(313) 447-0888
Fax
(313) 458-4004
NPI assigned
Dec 25, 2021
Last updated
May 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2022

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

Authorized official

Name
Ghattas Alkhoury, MDNPI 1215347000
Title
Medical Doctor/Owner
Phone
(419) 481-1945

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

2421 Monroe St Ste 102
Dearborn, MI 48124-3043

Mailing address

2421 Monroe St Ste 102
Dearborn, MI 48124-3043
Phone (313) 447-0888

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ghattas.alkhoury@wdearbornuc.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220113002553 MI Part B Supplier - Clinic/Group Practice 8729470281 Receives reassigned benefits from 4 practitioners
Practice locations: Dearborn, MI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2248896West Dearborn Urgent Care2421 Monroe Street Suite 102, Dearborn, MI 48124Certificate of waiverJan 17, 2028

National Provider Directory

National Provider Directory
Tax ID family
West Dearborn Primary Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2421 Monroe St
Ste 102
Dearborn, MI 48124
Phone (313) 447-0888

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1640390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651622400000",
    "number": "1124788666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2421 MONROE ST STE 102",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481243043",
            "telephone_number": "313-447-0888",
            "fax_number": "313-458-4004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2421 MONROE ST STE 102",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481243043",
            "telephone_number": "313-447-0888",
            "fax_number": "313-458-4004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST DEARBORN URGENT CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-25",
        "last_updated": "2022-05-04",
        "certification_date": "2022-05-04",
        "status": "A",
        "authorized_official_last_name": "ALKHOURY",
        "authorized_official_first_name": "GHATTAS",
        "authorized_official_title_or_position": "MEDICAL DOCTOR/OWNER",
        "authorized_official_telephone_number": "419-481-1945",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ghattas.alkhoury@wdearbornuc.com",
            "affiliation": "N",
            "endpointDescription": "Secure email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2421 Monroe St Ste 102",
            "city": "Dearborn",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481243043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.