Individual provider Active NPI

Sumbul Faiz Rahman, M.D.

  • Family Medicine Physician
  • Dearborn, MI
National Provider Identifier
1316010416
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301082647 Issued in MI
Practice address
1816 Grindley Park St
Dearborn, MI 48124-2504
Phone
(734) 934-4163
NPI assigned
Nov 16, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301082647 MI Primary

Addresses

Primary practice location

1816 Grindley Park St
Dearborn, MI 48124-2504

Mailing address

1816 Grindley Park St
Dearborn, MI 48124-2504
Phone (734) 934-4163

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070912000127 MI Practitioner - Family Practice 0244323848 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301082647MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Urgent Care PLLC Family Medicine CurrentSince Apr 22, 2015 Accepting new patients

Locations

1816 Grindley Park St
Ste 1
Dearborn, MI 48124
Phone (313) 792-1200

1816 Grindley Park St
Ste 2
Dearborn, MI 48124
Phone (313) 792-1200

1816 Grindley Park St
Dearborn, MI 48124
Phone (313) 792-1200

Interoperability endpoints

  • Direct secure messaging: srahman1252094@epic00.shdirect.org

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1316010416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1816 GRINDLEY PARK ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242504",
            "telephone_number": "734-934-4163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1816 GRINDLEY PARK ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242504",
            "telephone_number": "734-934-4163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAHMAN",
        "first_name": "SUMBUL",
        "middle_name": "FAIZ",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301082647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.