NPIMap

Organization Active NPI

Institute for Population Health Inc.

Doing business as School Health Center

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
National Provider Identifier
1174081277
Registry record updated Dec 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
INSTITUTE FOR POPULATION HEALTH INC.
Doing business as
School Health Center
Practice address
15491 Maddelein St
Detroit, MI 48205-2596
Phone
(313) 309-9350
Fax
(313) 309-5060
NPI assigned
Mar 7, 2019
Last updated
Dec 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2023

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

Authorized official

Name
Kimberly Williamson
Title
Revenue Manager
Phone
(313) 309-9350

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Primary Care Clinic/Center 261QP2300X NU
Public Health & General Preventive Medicine Physician 2083P0901X NU

Addresses

Primary practice location

15491 Maddelein St
Detroit, MI 48205-2596

Mailing address

15491 Maddelein St
Detroit, MI 48205-2596
Phone (313) 309-9350

Other identifiers 2

IdentifierTypeStateIssuer
71020000H28082OtherMIBLUE CROSS
231117MedicaidMI

Other names 1

  • School Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200622001973 MI Part A Provider - Federally Qualified Health Center (FQHC) 6002030095 Practice locations: Detroit, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174081277. Details of each certification follow.

Federally qualified health center certification: CCN 231168

Legal name
INSTITUTE FOR POPULATION HEALTH INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 19, 2020
Last certification
Jun 19, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 15, 2012 in MI
Enrollment address
15491 Maddelein St
Detroit, MI 48205-2596

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Institute for Population Health Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

15491 Maddelein St
Detroit, MI 48205
Phone (313) 309-9350

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Institute for Population Health Inc. Organization, Detroit, MI Corporation, Non-profit Operational/Managerial Control Oct 1, 2018
Gwendolyn Annette Daniels Individual Corporate OfficerCeo Oct 16, 2018
Kimberly Williamson Individual W-2 Managing EmployeeBilling/Revenue Manager Oct 16, 2018

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
WoodwardDetroit, MI, CCN 231117 Federally qualified health center General Partnership Interest Mar 1, 2017
Institute for Population Health Inc.Detroit, MI, CCN 231141 Federally qualified health center General Partnership Interest Mar 1, 2017

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1551916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702339200000",
    "number": "1174081277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15491 MADDELEIN ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482052596",
            "telephone_number": "313-309-9350",
            "fax_number": "313-309-5060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15491 MADDELEIN ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482052596",
            "telephone_number": "313-309-9350",
            "fax_number": "313-309-5060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSTITUTE FOR POPULATION HEALTH INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-07",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A",
        "authorized_official_last_name": "WILLIAMSON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "REVENUE MANAGER",
        "authorized_official_telephone_number": "313-309-9350"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "71020000H28082",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "231117",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "School Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.