NPIMap

Organization Active NPI

Northwest Dermatolgy Group, PC

  • MOHS-Micrographic Surgery Physician
  • Southfield, MI
National Provider Identifier
1285656777
Registry record updated Jul 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
Legal business name
NORTHWEST DERMATOLGY GROUP, PC
Practice address
29355 Northwestern Hwy
#200
Southfield, MI 48034
Phone
(248) 353-0880
NPI assigned
Jul 24, 2006
Reactivated
Jun 5, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2018

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

Authorized official

Name
Emily B Levin, MDNPI 1437140456
Title
President
Phone
(248) 353-0880

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X Primary

Addresses

Primary practice location

29355 Northwestern Hwy
#200
Southfield, MI 48034

Mailing address

29355 Northwestern Hwy
#200
Southfield, MI 48034-1053
Phone (248) 353-0880

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040604000608 MI Part B Supplier - Clinic/Group Practice 5799767596 Receives reassigned benefits from 4 practitioners
Practice locations: Bingham Farms, MI; Washington, MI

National Provider Directory

National Provider Directory

Locations

32270 Telegraph Rd
Ste 200
Bingham Farms, MI 48025
Phone (248) 353-0880

29255 Northwestern Hwy
Ste 200
Southfield, MI 48034
Phone (248) 353-0880

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532649600000",
    "number": "1285656777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29355 NORTHWESTERN HWY",
            "address_2": "#200",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341053",
            "telephone_number": "248-353-0880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29355 NORTHWESTERN HWY",
            "address_2": "#200",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48034",
            "telephone_number": "248-353-0880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST DERMATOLGY GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-24",
        "last_updated": "2018-07-27",
        "deactivation_date": "2018-02-11",
        "reactivation_date": "2018-06-05",
        "status": "A",
        "authorized_official_last_name": "LEVIN",
        "authorized_official_first_name": "EMILY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-353-0880",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.