NPIMap

Organization Active NPI

Cardiovascular Institute of Michigan, P.C.

  • Cardiovascular Disease Physician
  • Roseville, MI
National Provider Identifier
1154350890
Registry record updated Mar 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
CARDIOVASCULAR INSTITUTE OF MICHIGAN, P.C.
Practice address
18303 E 10 Mile Rd
Suite 100
Roseville, MI 48066-4988
Phone
(586) 776-8877
Fax
(586) 776-3092
NPI assigned
Jul 3, 2006
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. Mohamad K Ajjour, M.D.NPI 1083611172
Title
Administrator
Phone
(586) 776-8877

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
Cardiovascular Disease PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RC0000X Primary
Clinical Cardiac Electrophysiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RC0001X

Addresses

Primary practice location

18303 E 10 Mile Rd
Suite 100
Roseville, MI 48066-4988

Mailing address

18303 E 10 Mile Rd
Suite 100
Roseville, MI 48066-4988
Phone (586) 776-8877

Other identifiers 3

IdentifierTypeStateIssuer
CD6196OtherMIRAILROAD MEDICARE
M018365OtherMICHAMPUS GROUP
0E01050OtherMIBCBS GROUP

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040925000103 MI Part B Supplier - Clinic/Group Practice 1052380219 Receives reassigned benefits from 15 practitioners
Practice locations: Roseville, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300665600000",
    "number": "1154350890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18303 E 10 MILE RD",
            "address_2": "SUITE 100",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664988",
            "telephone_number": "586-776-8877",
            "fax_number": "586-776-3092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18303 E 10 MILE RD",
            "address_2": "SUITE 100",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664988",
            "telephone_number": "586-776-8877",
            "fax_number": "586-776-3092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARDIOVASCULAR INSTITUTE OF MICHIGAN, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2011-03-21",
        "status": "A",
        "authorized_official_last_name": "AJJOUR",
        "authorized_official_first_name": "MOHAMAD",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "586-776-8877",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CD6196",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS GROUP",
            "identifier": "M018365",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "0E01050",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.