Active NPI
MMG 1PC
- Family Medicine Physician
- West Bloomfield, MI
National Provider Identifier
1205855186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- MMG 1PC
- Practice address
- 7419 Middlebelt Rd
Suite 4
West Bloomfield, MI 48322-4182 - Phone
- (248) 855-2291
- Fax
- (248) 855-4901
- NPI assigned
- Jul 19, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Geoffrey A Trivax, MD
- Title
- President
- Phone
- (313) 538-3099
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary | ||
| Cardiovascular Disease Physician | 207RC0000X |
Addresses
Primary practice location
7419 Middlebelt Rd
Suite 4
West Bloomfield, MI 48322-4182
Mailing address
29992 Northwestern Hwy Ste C
Farmington Hills, MI 48334-3292
Phone (248) 851-1430
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 700F321510 | Other | MI | BLUE SHIELD GROUP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
Other NPIs on the same Medicare enrollment 9
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
7419 Middlebelt Rd
Ste 4
West Bloomfield, MI 48322
Phone (248) 855-2291
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Cardiovascular Disease Physician
- Southfield, MI
- NPI 1043259963
-
- Cardiovascular Disease Physician
- Southfield, MI
- NPI 1205942182
-
- Family Medicine Physician
- Farmington Hills, MI
- NPI 1962487041
-
- Cardiovascular Disease Physician
- Southfield, MI
- NPI 1225011711
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1537401600000",
"number": "1205855186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29992 NORTHWESTERN HWY STE C",
"city": "FARMINGTON HILLS",
"state": "MI",
"postal_code": "483343292",
"telephone_number": "248-851-1430",
"fax_number": "248-851-5182"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7419 MIDDLEBELT RD",
"address_2": "SUITE 4",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483224182",
"telephone_number": "248-855-2291",
"fax_number": "248-855-4901"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MMG 1PC",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-19",
"last_updated": "2018-09-20",
"status": "A",
"authorized_official_last_name": "TRIVAX",
"authorized_official_first_name": "GEOFFREY",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "313-538-3099",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "207RC0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD GROUP",
"identifier": "700F321510",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Bloomfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2018; 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.