Individual provider Active NPI

Houssam M Fadlallah, PA-C

  • Medical Physician Assistant
  • Dearborn, MI
National Provider Identifier
1215922109
Registry record updated Oct 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
5601003142 Issued in MI
Practice address
19855 Outer Dr Ste 207W
Dearborn, MI 48124-2193
Phone
(313) 327-0044
Fax
(313) 347-9026
NPI assigned
Sep 16, 2005
Last updated
Oct 5, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5601003142 MI Primary

Addresses

Primary practice location

19855 Outer Dr Ste 207W
Dearborn, MI 48124-2193

Mailing address

19855 Outer Dr Ste 207W
Dearborn, MI 48124-2193
Phone (313) 327-0044

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040611001039 MI Practitioner - Physician Assistant 2567451958 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Wayne State University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Patient First Care PLLCGroup PAC ID 4082996186, 4 clinicians
Powerback Rehabilitation LLCGroup PAC ID 2365359932, shared by 106 NPIs, 600 clinicians

Practice addresses (Care Compare)

43347 Riverbridge CT
Novi, MI 48375-4722
Phone (313) 675-9516

5025 Ann Arbor Rd
Jackson, MI 49201-8801
Phone (517) 879-1505

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Waterford Urgent Care PC Current Accepting new patients
Nextcare Michigan Providers PLLC Current Accepting new patients
Center Street Pharmacy PLLC PastSince Jul 9, 2025 Accepting new patients

Locations

3280 Washtenaw Ave
Ann Arbor, MI 48104
Phone (734) 225-9300

2300 Genoa Business Park Dr
Ste 120
Brighton, MI 48114
Phone (810) 299-8550

100 Powell Dr
Ste 8
Dundee, MI 48131
Phone (734) 823-5900

20311 Mack Ave
Grosse Pointe Woods, MI 48236
Phone (313) 499-6000

37595 7 Mile Rd
Livonia, MI 48152
Phone (734) 462-2300

5800 Highland Rd
Waterford, MI 48327
Phone (248) 290-5700

375 Eureka Rd
Ste B
Wyandotte, MI 48192
Phone (734) 225-9300

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1126828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791158400000",
    "number": "1215922109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19855 OUTER DR STE 207W",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242193",
            "telephone_number": "313-327-0044",
            "fax_number": "313-347-9026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19855 OUTER DR STE 207W",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242193",
            "telephone_number": "313-327-0044",
            "fax_number": "313-347-9026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FADLALLAH",
        "first_name": "HOUSSAM",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-16",
        "last_updated": "2026-10-05",
        "certification_date": "2026-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601003142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.