NPIMap

Organization Active NPI

Michigan Rehabilitation Physicians

  • Physical Medicine & Rehabilitation Physician
  • Detroit, MI
National Provider Identifier
1215240502
Registry record updated Apr 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
4301086814 Issued in MI
Legal business name
MICHIGAN REHABILITATION PHYSICIANS
Practice address
17187 Schaefer Hwy
Detroit, MI 48235-4132
Phone
(313) 367-2767
Fax
(313) 367-2818
NPI assigned
Jul 15, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2020

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

Authorized official

Name
Dr. Peter Hanna Gumma, MDNPI 1255564100
Title
Owner
Phone
(313) 367-2767

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X 4301086814 MI Primary

Addresses

Primary practice location

17187 Schaefer Hwy
Detroit, MI 48235-4132

Mailing address

PO Box 93
Fraser, MI 48026-0093

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110208000924 MI Part B Supplier - Clinic/Group Practice 4385824382 Receives reassigned benefits from 14 practitioners
Practice locations: Detroit, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1279152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587686400000",
    "number": "1215240502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 93",
            "city": "FRASER",
            "state": "MI",
            "postal_code": "480260093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17187 SCHAEFER HWY",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482354132",
            "telephone_number": "313-367-2767",
            "fax_number": "313-367-2818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN REHABILITATION PHYSICIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-15",
        "last_updated": "2020-04-24",
        "certification_date": "2020-04-24",
        "status": "A",
        "authorized_official_last_name": "GUMMA",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "HANNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-367-2767",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "4301086814",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Apr 24, 2020; 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.