NPIMap

Organization Active NPI

Detroit Wayne County Health Authority

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
National Provider Identifier
1245182963
Registry record updated Feb 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
DETROIT WAYNE COUNTY HEALTH AUTHORITY
Practice address
12121 Broadstreet Ave
Detroit, MI 48204-1550
Phone
(313) 824-1000
Fax
(313) 931-8656
NPI assigned
Feb 13, 2026
Last updated
Feb 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2026

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

Authorized official

Name
Loretta Violet Bush
Title
Ceo
Phone
(313) 824-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

12121 Broadstreet Ave
Detroit, MI 48204-1550

Mailing address

12121 Broadstreet Ave
Detroit, MI 48204-1550
Phone (313) 824-1000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260428002052 MI Part A Provider - Federally Qualified Health Center (FQHC) 4385982271 Practice locations: Detroit, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245182963. Details of each certification follow.

Federally qualified health center certification: CCN C71057

Legal name
DETROIT WAYNE COUNTY HEALTH AUTHORITY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 12, 2026
Last certification
Mar 12, 2026
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
12121 Broadstreet Ave
Detroit, MI 48204-1550

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Detroit Wayne County Health Authority3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jaye Clement Individual Corporate OfficerBoard Member Aug 14, 2024
Denise Brooks Williams Individual Corporate OfficerChairperson Jan 1, 2025
Loretta V Bush Individual Corporate OfficerCeo May 1, 2019
W-2 Managing EmployeeCeo May 1, 2019
Corliss Beard Individual Corporate OfficerCfo May 15, 2024
W-2 Managing EmployeeCfo May 15, 2024

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1770940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770940800000",
    "number": "1245182963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12121 BROADSTREET AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482041550",
            "telephone_number": "313-824-1000",
            "fax_number": "313-931-8656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12121 BROADSTREET AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482041550",
            "telephone_number": "313-824-1000",
            "fax_number": "313-931-8656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DETROIT WAYNE COUNTY HEALTH AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-02-13",
        "last_updated": "2026-02-13",
        "certification_date": "2026-02-13",
        "status": "A",
        "authorized_official_last_name": "BUSH",
        "authorized_official_first_name": "LORETTA",
        "authorized_official_middle_name": "VIOLET",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "313-824-1000"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.