Individual provider Active NPI

Alexander Munchiando, AGNP-C

  • Nurse Practitioner
  • Dearborn, MI
National Provider Identifier
1174048219
Registry record updated Sep 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704288308 Issued in MI
Practice address
15101 Ford Rd
Dearborn, MI 48126-4611
Phone
(877) 694-2612
NPI assigned
Aug 10, 2017
Last updated
Sep 11, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704288308 MI Primary
Registered Nurse 163W00000X 4704288308 MI

Addresses

Primary practice location

15101 Ford Rd
Dearborn, MI 48126-4611

Mailing address

31157 Woodward Ave
Royal Oak, MI 48073-0996

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171102000182 MI Practitioner - Nurse Practitioner 4385900695 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Michigan Institute of Urology PCGroup PAC ID 1052223492, 82 clinicians

Practice addresses (Care Compare)

130 Town Ctr Dr
Troy, MI 48084-1744
Phone (248) 740-0670

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704288308MIMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Physician Services of Michigan, P.C. Nurse Practitioner Current Accepting new patients
Michigan Healthcare Professionals PC CurrentSince Oct 7, 2019 Accepting new patients
Alliance Physician Services of Michigan, P.C. Nurse Practitioner CurrentSince Jul 29, 2024 Accepting new patients
Michigan Institute of Urology PC CurrentSince Jul 29, 2024 Accepting new patients
Michigan Healthcare Professionals PC CurrentSince Oct 7, 2019 Accepting new patients

Locations

21510 Harrington St
Ste 301
Clinton Twp, MI 48036
Phone (586) 464-3661

27900 Grand River Ave
Ste 220
Farmington Hills, MI 48336
Phone (248) 477-0552

29992 Northwestern Hwy
Ste C
Farmington Hills, MI 48334
Phone (248) 851-1430

17405 Hall Rd
Ste B
Macomb, MI 48044
Phone (586) 228-0150

1221 Pine Grove Ave
Port Huron, MI 48060
Phone (810) 989-3300

31157 Woodward Ave
Royal Oak, MI 48073
Phone (248) 288-2250

20952 E 12 Mile Rd
Ste 200
St Clr Shores, MI 48081
Phone (586) 771-4820

130 Town Center Dr
Ste 101
Troy, MI 48084
Phone (248) 740-0670

130 Town Center Dr
Ste 200
Troy, MI 48084
Phone (248) 740-0670

28565 Schoenherr Rd
Warren, MI 48088
Phone (586) 576-4140

Interoperability endpoints

  • Direct secure messaging: amunchiando1142442@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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1502323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568160000000",
    "number": "1174048219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31157 WOODWARD AVE",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480730996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15101 FORD RD",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481264611",
            "telephone_number": "877-694-2612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUNCHIANDO",
        "first_name": "ALEXANDER",
        "name_prefix": "Mr.",
        "credential": "AGNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-10",
        "last_updated": "2019-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704288308",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704288308",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.