Omar Ayman Soubani, DO

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

5101026891 Issued in MI

Practice address

3901 Chrysler Service Drive
Detroit, MI 48201-2167

Phone

(313) 577-7523

Fax

(313) 577-8823

NPI assigned

Apr 24, 2019

Last updated

Jul 24, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Psychiatry

Education

Michigan State University College of Osteopathic Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

University Physician GroupGroup PAC ID 8628087681, 399 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Detroit Receiving Hospital Hospital, Detroit, MI, CCN 230273
• Harper University Hospital Hospital, Detroit, MI, CCN 230104

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: omar.soubani.1@19711.direct.athenahealth.com
• Direct secure messaging: osoubani882597@direct.hfhs.org

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.

• University Physician Group

  dba Wayne Health

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1447299797
  Medicare reassignment Care Compare group NPD
• Ghazwan Atto MD PC

  dba Downriver Medical Associates

  • Internal Medicine Physician
  • Wyandotte, MI
  • NPI 1669554903
  Medicare reassignment NPD
• Neighborhood Service Organization

  • Community/Behavioral Health Agency
  • Detroit, MI
  • NPI 1891825808
  Medicare reassignment NPD
• State of Michigan Office of Financial Management

  dba State of Michigan

  • Psychiatric Hospital
  • Westland, MI
  • NPI 1508883299
  Medicare reassignment NPD
• Wayne County Treasurer-Payroll County of Wayne

  • Federally Qualified Health Center (FQHC)
  • Hamtramck, MI
  • NPI 1700215977
  Medicare reassignment NPD
• Dma Urgent Care, PLLC

  dba DMA Urgent Care

  • Urgent Care Clinic/Center
  • Wyandotte, MI
  • NPI 1962953216
  NPD
• State of Michigan Office of Financial Management

  dba Caro Psychiatric Hospital

  • Psychiatric Hospital
  • Caro, MI
  • NPI 1194767996
  NPD
• State of Michigan Office of Financial Management

  dba Michigan Veteran Homes at Chesterfield Twp

  • Skilled Nursing Facility
  • Chesterfield, MI
  • NPI 1497342653
  NPD
• Wayne County Treasurer Payroll-County of Wayne

  • Federally Qualified Health Center (FQHC)
  • Wayne, MI
  • NPI 1538543160
  NPD

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

• VHS Detroit Receiving Hospital Inc

  dba Detroit Receiving Hospital

  • General Acute Care Hospital
  • Detroit, MI
  • NPI 1619289998
  Care Compare affiliation
• VHS Harper-Hutzel Hospital Inc

  dba Harper University Hospital

  • General Acute Care Hospital
  • Detroit, MI
  • NPI 1427360700
  Care Compare affiliation

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

{
    "created_epoch": "1556064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690156800000",
    "number": "1255995346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 CHRYSLER SERVICE DRIVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 CHRYSLER SERVICE DRIVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012167",
            "telephone_number": "313-577-7523",
            "fax_number": "313-577-8823"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27998 Trailwood Ct",
            "address_purpose": "LOCATION",
            "city": "Farmington Hills",
            "state": "MI",
            "postal_code": "483312946",
            "country_code": "US",
            "telephone_number": "248-766-3041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOUBANI",
        "first_name": "OMAR",
        "middle_name": "AYMAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-24",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "5101026891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexa Soto
• Jesenia Soto, BCBA
• Kenndal Soto, AGACNP-BC
• Melissa Marie Soto
• Ayman Omar Soubani, MD
• Fadia A Soueidan, RRT
• Soul Fire Productions LLC
• Brittany A Soule, RBT
• Patrick Soule
• Soulstead Echo Ridge LLC

• Psychiatry Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.