NPIMap

Individual provider Active NPI

Justin Elijah Trivax, M.D.

  • Cardiovascular Disease Physician
  • Bingham Farms, MI
National Provider Identifier
1174566095
Registry record updated Dec 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
4301081886 Issued in MI
Practice address
31500 Telegraph Rd
Suite 115
Bingham Farms, MI 48025-4367
Phone
(248) 594-4913
Fax
(248) 594-4928
NPI assigned
Jun 14, 2006
Last updated
Dec 20, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301081886 MI
Cardiovascular Disease Physician 207RC0000X 4301081886 MI Primary

Addresses

Primary practice location

31500 Telegraph Rd
Suite 115
Bingham Farms, MI 48025-4367

Mailing address

29992 Northwestern Hwy
Suite C
Farmington Hills, MI 48334-3292
Phone (248) 851-1430

Other identifiers 2

IdentifierTypeStateIssuer
700H273300OtherMIBLUE SHIELD
1174566095MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060814000079 MI Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 9537162565 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology), Internal Medicine
Education
Wayne State University School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Omg 1PCGroup PAC ID 4183536238, 20 clinicians
MMG 1 PCGroup PAC ID 6103738638, 7 clinicians
Atria Vascular and Vein, PLLCGroup PAC ID 1850701616, 4 clinicians

Practice addresses (Care Compare)

27483 Dequindre Rd
Suite 101
Madison Heights, MI 48071-5700
Phone (248) 544-9050

27900 Grand River Ave
Suite 220
Farmington Hills, MI 48336-5965
Phone (248) 477-0552

32255 Northwestern Hwy
Suite 100
Farmington Hills, MI 48334-1573
Phone (248) 945-0000

32255 Northwestern Hwy
Suite 115a
Farmington Hills, MI 48334-1566
Phone (248) 587-2300

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting28
Pacemaker insertion or repair1-10
Varicose vein removal14
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301081886MIMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oakland Medical Group PC Internal Medicine CurrentSince Jul 7, 2013 Accepting new patients
Michigan Healthcare Professionals PC Internal Medicine CurrentSince Nov 1, 2011 Accepting new patients
Henry Ford Health Macomb Oakland Hospital Cardiovascular Disease CurrentSince Sep 17, 2017 Accepting new patients
Henry Ford Health Macomb-Oakland Hospital CurrentSince Sep 17, 2017 Accepting new patients
Omg 1 PC Internal Medicine CurrentSince Jul 7, 2013 Accepting new patients
Atria Vascular & Vein, PLLC Cardiovascular Disease CurrentSince Feb 21, 2020 Accepting new patients
MMG 1 PC Internal Medicine CurrentSince Jul 1, 2010 Accepting new patients
MMG 1 PC Internal Medicine CurrentSince Jul 1, 2010 Accepting new patients
Michigan Healthcare Professionals PC CurrentSince Nov 1, 2011 Accepting new patients
Major Hospital Past Accepting new patients

Locations

31500 Telegraph Rd
Ste 115
Bingham Farms, MI 48025
Phone (248) 621-9100

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

32255 Northwestern Hwy
Ste 100
Farmington Hills, MI 48334
Phone (248) 945-0000

32255 Northwestern Hwy
Ste 115
Farmington Hills, MI 48334
Phone (248) 587-2300

32255 Northwestern Hwy
Ste 115A
Farmington Hills, MI 48334
Phone (248) 268-4296

32255 Northwestern Hwy
Ste 170
Farmington Hills, MI 48334
Phone (248) 932-1250

32255 Northwestern Hwy
Ste 40
Farmington Hills, MI 48334
Phone (248) 355-3875

27483 Dequindre Rd
Ste 104
Madison Heights, MI 48071
Phone (248) 587-2300

27483 Dequindre Rd
Ste 210
Madison Heights, MI 48071
Phone (248) 398-0964

27351 Dequindre Rd
Madison Hts, MI 48071
Phone (248) 967-7000

27483 Dequindre Rd
Madison Hts, MI 48071
Phone (248) 544-9050

27483 Dequindre Rd
Ste 101
Madison Hts, MI 48071
Phone (248) 544-9050

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

28625 Northwestern Hwy
Ste 213
Southfield, MI 48034
Phone (248) 354-9666

6149 N Wayne Rd
Westland, MI 48185
Phone (734) 728-1320

Interoperability endpoints

  • Direct secure messaging: jtrivax1155942@direct.hfhs.org

Organizations & group practices 10

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355961600000",
    "number": "1174566095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29992 NORTHWESTERN HWY",
            "address_2": "SUITE C",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483343292",
            "telephone_number": "248-851-1430",
            "fax_number": "248-851-5182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31500 TELEGRAPH RD",
            "address_2": "SUITE 115",
            "city": "BINGHAM FARMS",
            "state": "MI",
            "postal_code": "480254367",
            "telephone_number": "248-594-4913",
            "fax_number": "248-594-4928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRIVAX",
        "first_name": "JUSTIN",
        "middle_name": "ELIJAH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2012-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301081886",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": "4301081886",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "700H273300",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174566095",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bingham Farms, MI

Sources for this page

Verify at the official NPI Registry.