Individual provider Active NPI

John George Ghanem, M.D.

  • Anesthesiology Physician
  • Detroit, MI
National Provider Identifier
1255628442
Registry record updated Oct 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
4301099377 Issued in MI
Practice address
4201 St Antoine St.
Detroit, MI 48201
Phone
(313) 745-3000
NPI assigned
Jul 7, 2011
Last updated
Oct 15, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 4301099377 MI Primary

Addresses

Primary practice location

4201 St Antoine St.
Detroit, MI 48201

Mailing address

4201 St Antoine St.
Detroit, MI 48201
Phone (313) 745-3000

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160203000415 MI Practitioner - Anesthesiology 6204137078 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Services Associates PCGroup PAC ID 4385557602, 67 clinicians

Practice addresses (Care Compare)

1101 W University Dr
Crittenton Hospital Medical Center
Rochester, MI 48307-1863
Phone (248) 652-5000

11800 E 12 Mile Rd
Warren, MI 48093-3472
Phone (586) 573-5000

1221 Pine Grove Ave
Port Huron, MI 48060-3511
Phone (810) 987-5000

1221 Pine GRV
Port Huron, MI 48060-3511

21510 Harrington St
Suite 300
Clinton Township, MI 48036-2378
Phone (586) 323-4575

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Michigan Interventional Pain Center,PC CurrentSince Jul 1, 2016 Accepting new patients
Anesthesia Services Associates, PC Anesthesiology CurrentSince Nov 15, 2017 Accepting new patients
University Pain Clinic Associates, PLLC CurrentSince Aug 19, 2016 Accepting new patients
Northstar Anesthesia of Michigan PLLC Anesthesiology CurrentSince Dec 29, 2015 Accepting new patients
Lakes Anesthesia, PLC Anesthesiology PastSince Jan 1, 2026 Accepting new patients

Locations

19725 Allen Rd
Ste A
Brownstown Twp, MI 48183
Phone (734) 479-7246

24430 Ford Rd
Ste A
Dearborn Heights, MI 48127
Phone (313) 274-1292

3990 John R St
Detroit, MI 48201
Phone (313) 745-6211

4160 John R St
Ste 522
Detroit, MI 48201
Phone (313) 745-1293

4201 Saint Antoine St
Detroit, MI 48201
Phone (313) 745-3615

1000 W University Dr
Ste 100
Rochester, MI 48307
Phone (248) 402-0266

432 W University Dr
Rochester, MI 48307
Phone (248) 651-6122

Interoperability endpoints

  • Direct secure messaging: jghanem@direct.dmc.org
  • Direct secure messaging: jghanem1129913@direct.hfhs.org
  • Direct secure messaging: jghanem424831@direct.hfhs.org

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 5

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": "1309996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318636800000",
    "number": "1255628442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 ST ANTOINE ST.",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48201",
            "telephone_number": "313-745-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 ST ANTOINE ST.",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48201",
            "telephone_number": "313-745-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHANEM",
        "first_name": "JOHN",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-07",
        "last_updated": "2011-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "4301099377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.