Downriver Clinic PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301091157 Issued in MI

Legal business name

DOWNRIVER CLINIC PC

Practice address

8944 Macomb St
Grosse Ile, MI 48138-2089

Phone

(734) 675-0705

Fax

(734) 675-0747

NPI assigned

Jan 14, 2009

Last updated

Jul 15, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mounir Khaled, MDNPI 1760678809

Title

Owner Medical Director Physician

Phone

(734) 675-0705

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Tax ID family

Downriver Clinic2 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.

• Downriver Clinic PC

  • Urgent Care Clinic/Center
  • Grosse Ile, MI
  • NPI 1104063817
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mounir Khaled, M.D.

  • Internal Medicine Physician
  • Grosse Ile, MI
  • NPI 1760678809
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1231891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279152000000",
    "number": "1205073285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8944 MACOMB ST",
            "city": "GROSSE ILE",
            "state": "MI",
            "postal_code": "481382089",
            "telephone_number": "734-675-0705",
            "fax_number": "734-675-0747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8944 MACOMB ST",
            "city": "GROSSE ILE",
            "state": "MI",
            "postal_code": "481382089",
            "telephone_number": "734-675-0705",
            "fax_number": "734-675-0747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOWNRIVER CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-14",
        "last_updated": "2010-07-15",
        "status": "A",
        "authorized_official_last_name": "KHALED",
        "authorized_official_first_name": "MOUNIR",
        "authorized_official_title_or_position": "OWNER MEDICAL DIRECTOR PHYSICIAN",
        "authorized_official_telephone_number": "734-675-0705",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301091157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205073285",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DO7341",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "110H242960",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT LAKES",
            "identifier": "174382",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROCARE",
            "identifier": "82028050",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR",
            "identifier": "614738100",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR STATE",
            "identifier": "259686",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jonathan Michael Cugini, LMSW
• Sheryl A Czopek, RN
• Dayo Sudiyah Davis
• Kira Lynn Derupa
• Downriver Clinic PC
• Egger Medical PLLC
• Nadia Ibrahim El Khatib, PHARMD
• Eldercare Home Care Group, Inc
• Elizabeth Ann Feirtag, PTA
• Natasha Gandhi, PA-C

• Internal Medicine Physician in Grosse Ile, MI
• Providers in Grosse Ile, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2010; 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.