Platinum Management LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PLATINUM MANAGEMENT LLC

Practice address

5250 Auto Club Dr Ste 170
Dearborn, MI 48126-2619

Phone

(313) 335-9800

Fax

(313) 359-8305

NPI assigned

Sep 9, 2021

Organization subpart

No

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

Authorized official

Name

Autumn Nicole Manis

Title

Admin

Phone

(313) 359-8300

Specialties & licenses 2

Addresses

Other names 1

• MOVI ASC Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Listed as

Platinum Management LLC Dba Movi ASCCCN 23C0001153

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Movi ASC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Movi ASC Management LLC

  • Ambulatory Surgical Clinic/Center
  • Dearborn, MI
  • NPI 1992339147
  NPD tax ID

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elias Habib Kassab, M.D.

  • Cardiovascular Disease Physician
  • Dearborn, MI
  • NPI 1922076835
  NPD
• Tracy Rinzivillo

  • Cardiovascular Disease Physician
  • Jeannette, PA
  • NPI 1588017016
  NPD

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

{
    "created_epoch": "1631145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668556800000",
    "number": "1194494484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5250 AUTO CLUB DR STE 170",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262619",
            "telephone_number": "313-359-8300",
            "fax_number": "313-359-8305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5250 AUTO CLUB DR STE 170",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262619",
            "telephone_number": "313-335-9800",
            "fax_number": "313-359-8305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLATINUM MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-09",
        "last_updated": "2022-11-16",
        "certification_date": "2022-11-16",
        "status": "A",
        "authorized_official_last_name": "MANIS",
        "authorized_official_first_name": "AUTUMN",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "ADMIN",
        "authorized_official_telephone_number": "313-359-8300"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOVI ASC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MOVI ASC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tiffany Pittman
• Place of Hope PLC
• Mary Placido, FNP-BC
• Douglas G Plagens, M.D.
• Plastic Surgery Clinic P.C.
• Platinum Medical Supply LLC
• McKenzie Barnes Platt, P.A.
• Andrew Joseph Plaza, DNP, RN, AGACNP-BC
• Meghan O'Bryan Plaza
• Carli Pletzke

• Ambulatory Surgical Clinic/Center in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Ambulatory Surgical Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.