NPIMap

Organization Active NPI

University Physician Group

Doing business as Wayne State University Physician Group

  • Counselor
  • Detroit, MI
National Provider Identifier
1265647481
Registry record updated Oct 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Legal business name
UNIVERSITY PHYSICIAN GROUP
Doing business as
Wayne State University Physician Group
Practice address
3901 Beaubien St
4TH FLR Carls BLDG
Detroit, MI 48201-2119
Phone
(313) 745-4878
Fax
(313) 993-0282
NPI assigned
May 11, 2007
Last updated
Oct 26, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2016

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

Authorized official

Name
Mr. Jeffery P Kohlitz
Title
Chief Financial Officer
Phone
(248) 581-5930

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X Primary
Clinical Neuropsychologist 103G00000X
Psychologist 103T00000X
Social Worker 104100000X
Marriage & Family Therapist 106H00000X
Psychiatry Physician 2084P0800X

Addresses

Primary practice location

3901 Beaubien St
4TH FLR Carls BLDG
Detroit, MI 48201-2119

Mailing address

1560 E Maple Rd
Ste 400-Credentialing Dept.
Troy, MI 48083-1138
Phone (248) 581-5973

Other identifiers 10

IdentifierTypeStateIssuer
0P30630OtherMIMEDICARE GROUP # - MD/DO
0P32050OtherMIMEDICARE GROUP # - SOCIAL WORKER
0P32060OtherMIMEDICARE GROUP # - PSYCHOLOGIST/NEUROPSYCHOLOGIST
0P32180OtherMIMEDICARE GROUP # - NP
0H22821OtherMIBCBSM GROUP #
0H228310OtherMIBCBSM GROUP # - NP
0H22874OtherMIBCBSM GROUP # - PSYCHOLOGIST/NEUROPSYCHOLOGIST
0H22872OtherMIBCBSM GROUP # - SOCIAL WORKER
0P32120OtherMIMEDICARE GROUP # - MD/DO FEE LOCALITY 99
0H22832OtherMIBCBSM GROUP # - MD/DO

Other names 1

  • Wayne State University Physician Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
University Physician Group13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477440000000",
    "number": "1265647481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 E MAPLE RD",
            "address_2": "STE 400-CREDENTIALING DEPT.",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831138",
            "telephone_number": "248-581-5973",
            "fax_number": "248-581-5640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 BEAUBIEN ST",
            "address_2": "4TH FLR CARLS BLDG",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012119",
            "telephone_number": "313-745-4878",
            "fax_number": "313-993-0282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY PHYSICIAN GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2016-10-26",
        "status": "A",
        "authorized_official_last_name": "KOHLITZ",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "248-581-5930",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP # - MD/DO",
            "identifier": "0P30630",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP # - SOCIAL WORKER",
            "identifier": "0P32050",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP # - PSYCHOLOGIST/NEUROPSYCHOLOGIST",
            "identifier": "0P32060",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP # - NP",
            "identifier": "0P32180",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM GROUP #",
            "identifier": "0H22821",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM GROUP # - NP",
            "identifier": "0H228310",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM GROUP # - PSYCHOLOGIST/NEUROPSYCHOLOGIST",
            "identifier": "0H22874",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM GROUP # - SOCIAL WORKER",
            "identifier": "0H22872",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP # - MD/DO FEE LOCALITY 99",
            "identifier": "0P32120",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM GROUP # - MD/DO",
            "identifier": "0H22832",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wayne State University Physician Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.