NPIMap

Organization Active NPI

Senior Care Medical Group PLLC

  • Internal Medicine Physician
  • Dearborn, MI
National Provider Identifier
1285660571
Registry record updated Aug 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
BA059825 Issued in MI
Legal business name
SENIOR CARE MEDICAL GROUP PLLC
Practice address
15400 Michigan Ave
Suite One
Dearborn, MI 48126-3491
Phone
(313) 584-3359
Fax
(313) 584-1729
NPI assigned
Jun 25, 2006
Last updated
Aug 26, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2013

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

Authorized official

Name
Dr. Belal F Abdallah, MDNPI 1447230941
Title
Owner
Phone
(313) 945-5450

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Long-Term Care Clinical Nurse Specialist 364SL0600X KM171632 MI
Long-Term Care Clinical Nurse Specialist 364SL0600X MZ112158 MI
Internal Medicine Physician 207R00000X BA059825 MI Primary

Addresses

Primary practice location

15400 Michigan Ave
Suite One
Dearborn, MI 48126-3491

Mailing address

15400 Michigan Ave
Ste (1)
Dearborn, MI 48126
Phone (313) 584-3359

Other identifiers 1

IdentifierTypeStateIssuer
4933009MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060818000338 MI Part B Supplier - Clinic/Group Practice 7416950118 Receives reassigned benefits from 8 practitioners
Practice locations: Dearborn, MI

National Provider Directory

National Provider Directory

Locations

27015 W Warren St
Ste 1
Dearborn Heights, MI 48127
Phone (313) 562-1030

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377475200000",
    "number": "1285660571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15400 MICHIGAN AVE",
            "address_2": "STE (1)",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "48126",
            "telephone_number": "313-584-3359",
            "fax_number": "313-584-1729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15400 MICHIGAN AVE",
            "address_2": "SUITE ONE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481263491",
            "telephone_number": "313-584-3359",
            "fax_number": "313-584-1729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR CARE MEDICAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2013-08-26",
        "status": "A",
        "authorized_official_last_name": "ABDALLAH",
        "authorized_official_first_name": "BELAL",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-945-5450",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "364SL0600X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Long-Term Care",
            "state": "MI",
            "license": "KM171632",
            "primary": false
        },
        {
            "code": "364SL0600X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Long-Term Care",
            "state": "MI",
            "license": "MZ112158",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "BA059825",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4933009",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2013; 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.