Active NPI
Shadi M Fahs, DO
- Surgery Physician
- Dearborn, MI
National Provider Identifier
1144209883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 5101014583
- Practice address
- 23855 Michigan Ave
Dearborn, MI 48124-1805 - Phone
- (313) 769-5656
- Fax
- (313) 769-5658
- NPI assigned
- Jan 11, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 5101014583 | MI | Primary |
Addresses
Primary practice location
23855 Michigan Ave
Dearborn, MI 48124-1805
Mailing address
23855 Michigan Ave
Dearborn, MI 48124-1805
Phone (313) 769-5656
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 238601 | Other | MI | MEDICARE RURAL HEALTH CLINIC NUMBER |
| 4938598 | Medicaid | MI | |
| CA1068 | Other | MI | RAILROAD MEDICAER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051007000106 | MI | Practitioner - General Surgery | 9436174687 | Reassigns benefits to 2 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- General Surgery
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
23855 Michigan Ave
Dearborn, MI 48124-1805
Phone 31376956561
904 Mason St
Dearborn, MI 48124-2215
Phone 31376956561
Hospital & facility affiliations
- Beaumont Hospital - Dearborn
- Garden City Hospital
- Beaumont Hospital - Taylor
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 31 |
| Hernia repair (minimally invasive) | 1-10 |
| Upper gastrointestinal (GI) endoscopy for acid reflux | 15 |
| Removal of tissue | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bronson Lakeview Hospital | Current | Accepting new patients | |
| Bronson Lakeview Hospital | Surgery | Current | Accepting new patients |
| Ma Sobh DO PLC | Past | Accepting new patients | |
| Prime Healthcare Services - Garden City LLC | Past | Accepting new patients |
Locations
601 John St
Kalamazoo, MI 49007
Phone (269) 341-7100
404 Hazen St
Ste 101
Paw Paw, MI 49079
Phone (269) 657-2550
451 Health Pkwy
Paw Paw, MI 49079
Phone (269) 655-1725
Interoperability endpoints
- sfahs630805@direct.hfhs.org
Organizations & group practices 5
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.
-
- Rural Health Clinic/Center
- South Haven, MI
- NPI 1801538871
-
- Cardiovascular Disease Physician
- Dearborn, MI
- NPI 1568889376
-
- General Acute Care Hospital
- Garden City, MI
- NPI 1043625940
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Garden City, MI
- NPI 1043625940
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1449619200000",
"number": "1144209883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23855 MICHIGAN AVE",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481241805",
"telephone_number": "313-769-5656",
"fax_number": "313-769-5658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23855 MICHIGAN AVE",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481241805",
"telephone_number": "313-769-5656",
"fax_number": "313-769-5658"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAHS",
"first_name": "SHADI",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-11",
"last_updated": "2015-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MI",
"license": "5101014583",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RURAL HEALTH CLINIC NUMBER",
"identifier": "238601",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4938598",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICAER",
"identifier": "CA1068",
"state": "MI"
}
],
"endpoints": [],
"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 Dec 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.