NPIMap

Organization Active NPI

Oakwood Healthcare, Inc.

Doing business as Beaumont Hospital - Wayne

  • Diagnostic Radiology Physician
  • Wayne, MI
National Provider Identifier
1225042963
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
820010 Issued in MI
Legal business name
OAKWOOD HEALTHCARE, INC.
Doing business as
Beaumont Hospital - Wayne
Practice address
33155 Annapolis St
Wayne, MI 48184-2405
Phone
(734) 467-4000
Fax
(734) 467-4017
NPI assigned
Jul 28, 2006
Last updated
Apr 22, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
OAKWOOD HEALTHCARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 22, 2024

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

Authorized official

Name
Lesley Willbrandt
Title
Director Shared Services
Phone
(947) 522-1911

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 820010 MI Primary

Addresses

Primary practice location

33155 Annapolis St
Wayne, MI 48184-2405

Mailing address

26901 Beaumont Blvd.
Compliance
Southfield, MI 48033-4716
Phone (947) 522-1963

Other identifiers 5

IdentifierTypeStateIssuer
0Q24603OtherMIBSHIELD/BCN
OP821157OtherMIM-CARE PROFESSIONAL
102788722MedicaidMI
110242923OtherMIRAIL ROAD PROFESSIONAL
000000001928OtherMICAPE HEALTH PROFESSIONAL

Other names 1

  • Beaumont Hospital - Wayne Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.beaumont.edu

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031205000505 MI Part B Supplier - Clinic/Group Practice 1254236839 Receives reassigned benefits from 33 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dearborn, MI; Taylor, MI; Trenton, MI; Wayne, MI

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Peter Zahos MD28 organizations share this tax ID, including this one
Part of
Peter Zahos MD

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713744000000",
    "number": "1225042963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD.",
            "address_2": "COMPLIANCE",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480334716",
            "telephone_number": "947-522-1963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33155 ANNAPOLIS ST",
            "city": "WAYNE",
            "state": "MI",
            "postal_code": "481842405",
            "telephone_number": "734-467-4000",
            "fax_number": "734-467-4017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAKWOOD HEALTHCARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OAKWOOD HEALTHCARE, INC.",
        "enumeration_date": "2006-07-28",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A",
        "authorized_official_last_name": "WILLBRANDT",
        "authorized_official_first_name": "LESLEY",
        "authorized_official_title_or_position": "DIRECTOR SHARED SERVICES",
        "authorized_official_telephone_number": "947-522-1911"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "820010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BSHIELD/BCN",
            "identifier": "0Q24603",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "M-CARE PROFESSIONAL",
            "identifier": "OP821157",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102788722",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD PROFESSIONAL",
            "identifier": "110242923",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPE HEALTH PROFESSIONAL",
            "identifier": "000000001928",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "33155 Annapolis St",
            "city": "Wayne",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481842405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Beaumont Hospital - Wayne",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beaumont Hospital - Wayne",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wayne, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; 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.