Individual provider Active NPI

Suzanne Benloucif-Moore, NP

  • Nurse Practitioner
  • Ann Arbor, MI
National Provider Identifier
1184784027
Registry record updated Aug 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704158416 Issued in MI
Practice address
1500 E Medical Center Dr
B1 Floor University Hospital Recp F
Ann Arbor, MI 48109-5856
Phone
(888) 287-1082
NPI assigned
Dec 11, 2006
Last updated
Aug 8, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704158416 MI Primary

Addresses

Primary practice location

1500 E Medical Center Dr
B1 Floor University Hospital Recp F
Ann Arbor, MI 48109-5856

Mailing address

3621 S State St
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

Other identifiers 1

IdentifierTypeStateIssuer
4441077MedicaidMI

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
I20100420001016 MI Practitioner - Nurse Practitioner 6608903836 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1500 E Medical Ctr Dr
Ann Arbor, MI 48109-5000
Phone (734) 936-4000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4704158416MIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Michigan Nurse Practitioner CurrentSince Aug 15, 2002 Accepting new patients
Regents of the University of Michigan CurrentSince Aug 15, 2002 Accepting new patients
Regents of the University of Michigan Past Accepting new patients
Regents of the University of Michigan PastSince May 24, 2011 Accepting new patients

Locations

1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280

1500 E Medical Center Dr
#B1
Ann Arbor, MI 48109
Phone (734) 936-4500

1500 E Medical Center Dr
Fl Cs
Ann Arbor, MI 48109
Phone (734) 615-7845

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

3621 S State St
#700
Ann Arbor, MI 48108

400 E Eisenhower Pkwy
Ste B
Ann Arbor, MI 48108
Phone (734) 232-2600

8001 Challis Rd
Brighton, MI 48116
Phone (810) 227-9510

39901 Traditions Dr
Ste 210
Northville, MI 48168
Phone (248) 305-4400

Organizations & group practices 4

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 1

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": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344384000000",
    "number": "1184784027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E MEDICAL CENTER DR",
            "address_2": "B1 FLOOR UNIVERSITY HOSPITAL RECP F",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095856",
            "telephone_number": "888-287-1082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENLOUCIF-MOORE",
        "first_name": "SUZANNE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-11",
        "last_updated": "2012-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704158416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4441077",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.