Active NPI
Theodore G. Mayer, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Detroit, MI
National Provider Identifier
1194732958
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 4301089187
- Practice address
- Henry Ford Health System
2799 West Grand Boulevard
Detroit, MI 48202 - Phone
- (313) 916-9106
- Fax
- (313) 916-1249
- NPI assigned
- Aug 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cytopathology Physician | 207ZC0500X | 4301089187 | MI | |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 4301089187 | MI | Primary |
Addresses
Primary practice location
Henry Ford Health System
2799 West Grand Boulevard
Detroit, MI 48202
Mailing address
Henry Ford Health System
2799 West Grand Boulevard
Detroit, MI 48202
Phone (313) 916-9106
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| TM089187 | Other | CHAMPUS-CHAMPUS | |
| TM089187 | Other | COMMERCIAL-COMMERCIAL NUMBER | |
| 888888810 | Medicaid | MI | |
| 700H262270 | Other | BLUE CROSS-BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473638400000",
"number": "1194732958",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "HENRY FORD HEALTH SYSTEM",
"address_2": "2799 WEST GRAND BOULEVARD",
"city": "DETROIT",
"state": "MI",
"postal_code": "48202",
"telephone_number": "313-916-9106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "HENRY FORD HEALTH SYSTEM",
"address_2": "2799 WEST GRAND BOULEVARD",
"city": "DETROIT",
"state": "MI",
"postal_code": "48202",
"telephone_number": "313-916-9106",
"fax_number": "313-916-1249"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYER",
"first_name": "THEODORE",
"middle_name": "G.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-02",
"last_updated": "2016-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "207ZC0500X",
"taxonomy_group": "",
"desc": "Pathology, Cytopathology",
"state": "MI",
"license": "4301089187",
"primary": false
},
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "MI",
"license": "4301089187",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS-CHAMPUS",
"identifier": "TM089187",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMERCIAL-COMMERCIAL NUMBER",
"identifier": "TM089187",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "888888810",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS-BLUE CROSS",
"identifier": "700H262270",
"state": null
}
],
"endpoints": [],
"other_names": []
}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 Sep 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.