NPIMap

Organization Active NPI

Detroit Community Health Connection, Inc

  • Multi-Specialty Clinic/Center
  • Detroit, MI
National Provider Identifier
1174906184
Registry record updated Jul 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
DETROIT COMMUNITY HEALTH CONNECTION, INC
Practice address
13901 E Jefferson Ave
Detroit, MI 48215-2720
Phone
(313) 343-2873
Fax
(313) 822-4202
NPI assigned
Jul 8, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2015

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

Authorized official

Name
Mahipal Rao Kakarala
Title
Cfo
Phone
(313) 821-2591

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

13901 E Jefferson Ave
Detroit, MI 48215-2720

Mailing address

13901 E Jefferson Ave
Detroit, MI 48215-2720
Phone (313) 343-2873

Other names 1

  • DCHC Hospital Care Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040326000067 MI Part B Supplier - Clinic/Group Practice 9234021148 Receives reassigned benefits from 23 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Detroit, MI

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Detroit Community Health Connection9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1436313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438128000000",
    "number": "1174906184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13901 E JEFFERSON AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482152720",
            "telephone_number": "313-343-2873",
            "fax_number": "313-822-4202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13901 E JEFFERSON AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482152720",
            "telephone_number": "313-343-2873",
            "fax_number": "313-822-4202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DETROIT COMMUNITY HEALTH CONNECTION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-08",
        "last_updated": "2015-07-29",
        "status": "A",
        "authorized_official_last_name": "KAKARALA",
        "authorized_official_first_name": "MAHIPAL",
        "authorized_official_middle_name": "RAO",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "313-821-2591"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DCHC Hospital Care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2015; 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.