Organization Active NPI

Samina Ansar Ghazi MD PC

  • Clinic/Center
  • Farmington Hills, MI
National Provider Identifier
1144366758
Registry record updated Mar 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
4301060000 Issued in MI
Legal business name
SAMINA ANSAR GHAZI MD PC
Practice address
33110 W 12 Mile Rd
Farmington Hills, MI 48334-3307
Phone
(248) 489-9070
Fax
(248) 489-9076
NPI assigned
Jan 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2011

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

Authorized official

Name
Dr. Samina Ansar Ghazi, M.D.NPI 1992754980
Title
Owner
Phone
(248) 489-9070

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 4301060000 MI Primary

Addresses

Primary practice location

33110 W 12 Mile Rd
Farmington Hills, MI 48334-3307

Mailing address

28907 E King William Dr
Farmington Hills, MI 48331-2579
Phone (248) 553-2886

Other identifiers 1

IdentifierTypeStateIssuer
4495327-10MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071012000638 MI Part B Supplier - Clinic/Group Practice 8628164183 Receives reassigned benefits from 5 practitioners
Practice locations: Farmington Hills, 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
23D1008952Samina Ansar Ghazi MD PC33110 W 12 Mile Road, Farmington Hills, MI 48334Certificate of waiverFeb 2, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300665600000",
    "number": "1144366758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28907 E KING WILLIAM DR",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483312579",
            "telephone_number": "248-553-2886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33110 W 12 MILE RD",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483343307",
            "telephone_number": "248-489-9070",
            "fax_number": "248-489-9076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMINA ANSAR GHAZI MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2011-03-21",
        "status": "A",
        "authorized_official_last_name": "GHAZI",
        "authorized_official_first_name": "SAMINA",
        "authorized_official_middle_name": "ANSAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-489-9070",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MI",
            "license": "4301060000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4495327-10",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington Hills, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2011; 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.