Individual provider Active NPI

Moustafa S Bazzi, MD

  • Sports Medicine (Family Medicine) Physician
  • Detroit, MI
National Provider Identifier
1265176747
Registry record updated Jun 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
4301511136 Issued in MI
Practice address
3370 E Jefferson Ave
Detroit, MI 48207-4236
Phone
(313) 656-1600
Fax
(313) 656-1610
NPI assigned
Apr 21, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301511136 MI
Sports Medicine (Family Medicine) Physician 207QS0010X 4301511136 MI Primary

Addresses

Primary practice location

3370 E Jefferson Ave
Detroit, MI 48207-4236

Mailing address

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

Other practice location 1

50 N Perry St
Pontiac, MI 48342-2217
Phone (248) 338-5392

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
I20250709000228 MI Practitioner - Family PracticePractitioner - Sports Medicine 1456721109 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

3370 E Jefferson Ave
Detroit, MI 48207-4236
Phone (313) 656-1600

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Henr Y Ford Health System Family Medicine CurrentSince Jun 1, 2025 Accepting new patients
Henry Ford Health System Current Accepting new patients
Henry Ford Health System CurrentSince Jun 1, 2025 Accepting new patients

Locations

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

1 Ford Pl
Ste 3A
Detroit, MI 48202
Phone (313) 874-2892

3370 E Jefferson Ave
Detroit, MI 48207
Phone (313) 656-1600

Interoperability endpoints

  • Direct secure messaging: moustafa.bazza.p1@direct.oihn.nextgenshare.com

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1650499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751241600000",
    "number": "1265176747",
    "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": "3370 E JEFFERSON AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482074236",
            "telephone_number": "313-656-1600",
            "fax_number": "313-656-1610"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "50 N Perry St",
            "address_purpose": "LOCATION",
            "city": "Pontiac",
            "state": "MI",
            "postal_code": "483422217",
            "country_code": "US",
            "telephone_number": "248-338-5392",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAZZI",
        "first_name": "MOUSTAFA",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-21",
        "last_updated": "2025-06-30",
        "certification_date": "2025-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301511136",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MI",
            "license": "4301511136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.