NPIMap

Individual provider Active NPI

Basel Brikho, MD

  • Internal Medicine Physician
  • Lathrup Village, MI
National Provider Identifier
1285721514
Registry record updated Jul 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301061420 Issued in MI
Practice address
18211 W 12 Mile Rd
Lathrup Village, MI 48076
Phone
(248) 557-4443
Fax
(248) 557-0573
NPI assigned
Oct 6, 2006
Last updated
Jul 6, 2017By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 6, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301061420 MI Primary
Pediatrics Physician 208000000X 4301061420 MI

Addresses

Primary practice location

18211 W 12 Mile Rd
Lathrup Village, MI 48076

Mailing address

18211 W 12 Mile Rd
Lathrup Village, MI 48076
Phone (248) 557-4443

Other identifiers 3

IdentifierTypeStateIssuer
4092397MedicaidMI
BB061420OtherMILICENSE
383461699OtherMITAX ID

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
I20080709000116 MI Practitioner - Internal MedicinePractitioner - Pediatric Medicine 4587736590 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Henry Ford Semi Medical GroupGroup PAC ID 0648180406, 246 clinicians

Practice addresses (Care Compare)

18211 W 12 Mile Rd
Lathrup Village, MI 48076-2641
Phone (248) 557-4443

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as apm

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301061420MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Semi Medical Group Pediatrics CurrentSince Aug 21, 2017 Accepting new patients
Henry Ford Semi Medical Group Internal Medicine CurrentSince Aug 21, 2017 Accepting new patients
Henry Ford Semi Medical Group Internal Medicine Current Accepting new patients
Ascension Macomb Oakland Hospital Past Accepting new patients

Locations

18211 W 12 Mile Rd
Lathrup Village, MI 48076
Phone (248) 557-4443

26850 Providence Pkwy
Ste 520
Novi, MI 48374
Phone (248) 465-3790

2800 Livernois Rd
Ste 500
Troy, MI 48083
Phone (586) 753-0400

Interoperability endpoints

  • Direct secure messaging: bbrikho1118770@direct.hfhs.org

Organizations & group practices 5

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

Hospital & facility affiliations 10

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": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1499299200000",
    "number": "1285721514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18211 W 12 MILE RD",
            "city": "LATHRUP VILLAGE",
            "state": "MI",
            "postal_code": "48076",
            "telephone_number": "248-557-4443",
            "fax_number": "248-557-0573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18211 W 12 MILE RD",
            "city": "LATHRUP VILLAGE",
            "state": "MI",
            "postal_code": "48076",
            "telephone_number": "248-557-4443",
            "fax_number": "248-557-0573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRIKHO",
        "first_name": "BASEL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2017-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301061420",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301061420",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4092397",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "BB061420",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "383461699",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lathrup Village, MI

Sources for this page

Verify at the official NPI Registry.