Individual provider Active NPI

Rana Tabassum, M.D.

  • Intellectual Disabilities Intermediate Care Facility
  • Detroit, MI
National Provider Identifier
1154619849
Registry record updated May 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
57735-20 Issued in WI
Practice address
6071 W Outer Dr
Detroit, MI 48235-2624
Phone
(313) 966-3250
NPI assigned
Jul 14, 2011
Last updated
May 21, 2018By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 21, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 57735-20 WI Primary
Internal Medicine Physician 207R00000X 4301099130 MI

Addresses

Primary practice location

6071 W Outer Dr
Detroit, MI 48235-2624

Mailing address

1125 Meadow Creek CT
Vernon Hills, IL 60061-2562
Phone (248) 952-1440

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131028001418 WI Practitioner - Internal Medicine 5890920847 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
State of WisconsinGroup PAC ID 9234181751, 8 clinicians

Practice addresses (Care Compare)

21425 Spring St
Union Grove, WI 53182-9707
Phone (262) 878-2411

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301099130MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
State of Wisconsin Multi-Specialty Current Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1310601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526860800000",
    "number": "1154619849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 MEADOW CREEK CT",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600612562",
            "telephone_number": "248-952-1440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6071 W OUTER DR",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482352624",
            "telephone_number": "313-966-3250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABASSUM",
        "first_name": "RANA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-14",
        "last_updated": "2018-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "WI",
            "license": "57735-20",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301099130",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.