Active NPI
Hazel Park Primary Care LLC
- Family Medicine Physician
- Hazel Park, MI
National Provider Identifier
1306407440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- HAZEL PARK PRIMARY CARE LLC
- Practice address
- 624 E 9 Mile Rd Ste B
Hazel Park, MI 48030-1842 - Phone
- (248) 629-7497
- Fax
- (248) 397-8474
- NPI assigned
- Jun 27, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mohamed G Saleh, MD
- Title
- President
- Phone
- (248) 629-7497
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | |||
| Family Medicine Physician | 207Q00000X | Primary | ||
| Addiction Medicine (Preventive Medicine) Physician | 2083A0300X |
Addresses
Primary practice location
624 E 9 Mile Rd Ste B
Hazel Park, MI 48030-1842
Mailing address
PO Box 365
Hazel Park, MI 48030-0365
Phone (248) 629-7497
Other practice location 1
704 E 9 Mile Rd
Hazel Park, MI 48030-1841
Phone (248) 439-9930
Other practice location 2
15450 Northline Rd Ste 101
Southgate, MI 48195-2490
Phone (734) 225-1315
Other names 1
- Neu Hope
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190917000580 | MI | Part B Supplier - Clinic/Group Practice | 2961731997 |
Receives reassigned benefits from 13 practitioners Practice locations: Hazel Park, MI; Southgate, MI |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D2179760 | Hazel Park Primary Care | Accreditation | Sep 9, 2026 |
| 23D2278268 | Hazel Park Primary Care | Certificate of waiver | Mar 13, 2027 |
| 23D2278695 | Hazel Park Primary Care | Certificate of waiver | Mar 21, 2027 |
National Provider Directory
National Provider DirectoryLocations
6245 Inkster Rd
Ste 304
Garden City, MI 48135
Phone (734) 458-3300
624 E 9 Mile Rd
Ste B
Hazel Park, MI 48030
Phone (248) 629-7497
Practitioners & affiliated clinicians
Practitioners 13
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Hazel Park, MI
- NPI 1861566598
Chiropractor, MI
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561593600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1691971200000",
"number": "1306407440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 365",
"city": "HAZEL PARK",
"state": "MI",
"postal_code": "480300365",
"telephone_number": "248-629-7497",
"fax_number": "248-397-8474"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "624 E 9 MILE RD STE B",
"city": "HAZEL PARK",
"state": "MI",
"postal_code": "480301842",
"telephone_number": "248-629-7497",
"fax_number": "248-397-8474"
}
],
"practiceLocations": [
{
"address_1": "704 E 9 Mile Rd",
"address_purpose": "LOCATION",
"city": "Hazel Park",
"state": "MI",
"postal_code": "480301841",
"country_code": "US",
"telephone_number": "248-439-9930",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "15450 Northline Rd Ste 101",
"address_purpose": "LOCATION",
"city": "Southgate",
"state": "MI",
"postal_code": "481952490",
"country_code": "US",
"telephone_number": "734-225-1315",
"fax_number": "877-892-4080",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "HAZEL PARK PRIMARY CARE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-06-27",
"last_updated": "2023-08-14",
"certification_date": "2023-08-14",
"status": "A",
"authorized_official_last_name": "SALEH",
"authorized_official_first_name": "MOHAMED",
"authorized_official_middle_name": "G",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "248-629-7497",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Chiropractor",
"state": null,
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "2083A0300X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Preventive Medicine, Addiction Medicine",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Neu Hope",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Hazel Park, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.