NPIMap

Individual provider Active NPI

Mohammad Khalil

  • Gerontology Nurse Practitioner
  • Wyandotte, MI
National Provider Identifier
1265028542
Registry record updated Jun 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
4704283791 Issued in MI
Practice address
2333 Biddle Ave
Wyandotte, MI 48192-4668
Phone
(734) 246-6000
NPI assigned
Dec 21, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 4704283791 MI Primary
Nurse Practitioner 363L00000X 4704283791 MI

Addresses

Primary practice location

2333 Biddle Ave
Wyandotte, MI 48192-4668

Mailing address

1 Ford PL Ste 3a
Detroit, MI 48202-3450
Phone (313) 874-4806

Other practice location 1

42195 Briarcliff Ct
Canton, MI 48187-3714
Phone (734) 447-6370

Other practice location 2

28050 Grand River Ave
Farmington Hills, MI 48336-5919
Phone (313) 618-9128

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mkhalil6544800@direct.beaumont.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210713000610 MI Practitioner - Nurse Practitioner 9436551546 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Wyandotte HospitalGroup PAC ID 2264334499, 194 clinicians
Beaumont Medical Group Hospital Based ServicesGroup PAC ID 3072875889, 575 clinicians

Practice addresses (Care Compare)

2333 Biddle Ave
Wyandotte, MI 48192-4668
Phone (734) 284-2400

28050 Grand River Ave
Farmington Hills, MI 48336-5919
Phone (947) 521-8196

44201 Dequindre Rd
Troy, MI 48085-1117
Phone (248) 964-1187

44201 Dequindre Rd Ec
Beaumont Emergency Services TR
Troy, MI 48085-1117
Phone (248) 964-5111

Hospital & facility affiliations

  • Wyandotte Hospital and Medical Center Hospital, Wyandotte, MI, CCN 230146
  • Beaumont Hospital - Farmington Hills Hospital, Farmington Hills, MI, CCN 230151
  • Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053

Merit-based Incentive Payment System (MIPS)

Final score
89.64 of 100Reported as group
Quality
85.06
Promoting interoperability
100
Improvement activities
40
Cost
77.9

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704283791MIMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Wyandotte Hospital CurrentSince Dec 1, 2025 Accepting new patients
Pioneer Medical Group PLLC CurrentSince Aug 16, 2021 Accepting new patients
Beaumont Medical Group Hospital -Based Services CurrentSince Jul 31, 2023 Accepting new patients
Henry Ford Wyandotte Hospital Current Accepting new patients
Henry Ford Wyandotte Hospital Nurse Practitioner CurrentSince Dec 1, 2025 Accepting new patients
Henry Ford Wyandotte Hospital Past Accepting new patients

Locations

6071 W Outer Dr
Detroit, MI 48235
Phone (313) 966-3300

28050 Grand River Ave
Farmington Hills, MI 48336
Phone (248) 471-8000

17177 N Laurel Park Dr
Ste 439
Livonia, MI 48152

44201 Dequindre Rd
Troy, MI 48085
Phone (248) 471-8255

2070 Biddle Ave
Ste 2
Wyandotte, MI 48192
Phone (734) 284-7482

2333 Biddle Ave
Wyandotte, MI 48192
Phone (734) 246-6000

Interoperability endpoints

  • Direct secure messaging: mkhalil6544800@direct.beaumont.edu

Organizations & group practices 14

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

View all 14

Hospital & facility affiliations 11

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": "1608508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781222400000",
    "number": "1265028542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 FORD PL STE 3A",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023450",
            "telephone_number": "313-874-4806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2333 BIDDLE AVE",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481924668",
            "telephone_number": "734-246-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "42195 Briarcliff Ct",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "MI",
            "postal_code": "481873714",
            "country_code": "US",
            "telephone_number": "734-447-6370",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "28050 Grand River Ave",
            "address_purpose": "LOCATION",
            "city": "Farmington Hills",
            "state": "MI",
            "postal_code": "483365919",
            "country_code": "US",
            "telephone_number": "313-618-9128",
            "fax_number": "248-471-8896",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHALIL",
        "first_name": "MOHAMMAD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-21",
        "last_updated": "2026-06-12",
        "certification_date": "2026-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MI",
            "license": "4704283791",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704283791",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mkhalil6544800@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "28050 Grand River Ave",
            "city": "Farmington Hills",
            "state": "MI",
            "country_code": "US",
            "postal_code": "483365919",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wyandotte, MI

Sources for this page

Verify at the official NPI Registry.