Individual provider Active NPI

Clifford N Owhor, PA-C

  • Medical Physician Assistant
  • Detroit, MI
National Provider Identifier
1316135379
Registry record updated Dec 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
5601002432 Issued in MI
Practice address
15400 W McNichols Rd
Detroit, MI 48235-3724
Phone
(131) 416-6262
NPI assigned
Oct 4, 2007
Last updated
Dec 16, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5601002432 MI Primary
Surgical Physician Assistant 363AS0400X 5601002432 MI

Addresses

Primary practice location

15400 W McNichols Rd
Detroit, MI 48235-3724

Mailing address

15400 W McNichols Rd
Detroit, MI 48235-3724
Phone (313) 416-6262

Other identifiers 1

IdentifierTypeStateIssuer
1316135379MedicaidMI

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071211000180 MI Practitioner - Physician Assistant 4284723412 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

15400 W McNichols Rd
Thea Bowman Community Center
Detroit, MI 48235-3724
Phone (313) 416-6262

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601002432MIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Detroit Health Care for the Homeless CurrentSince Mar 28, 2021 Accepting new patients
Detroit Health Care for the Homeless CurrentSince Mar 28, 2021 Accepting new patients
Detroit Health Care for the Homeless Past Accepting new patients
Ribhi Hazin MD PC PastSince Feb 1, 2020 Accepting new patients
Detroit Health Care for the Homeless Past Accepting new patients

Locations

100 River Place Dr
Ste 450
Detroit, MI 48207

101 E Alexandrine St
Detroit, MI 48201
Phone (313) 416-6262

1355 Oakman Blvd
Detroit, MI 48238
Phone (313) 416-6262

15400 W McNichols Rd
Detroit, MI 48235
Phone (313) 416-6262

15400 W McNichols Rd
Ste 400
Detroit, MI 48235

4777 E Outer Dr
Ste 1147
Detroit, MI 48234
Phone (313) 826-6100

4669 E 8 Mile Rd
Warren, MI 48091
Phone (313) 416-6200

Interoperability endpoints

  • Direct secure messaging: cowhor305618@direct.hfhs.org

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671148800000",
    "number": "1316135379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15400 W MCNICHOLS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482353724",
            "telephone_number": "313-416-6262",
            "fax_number": "855-643-6164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15400 W MCNICHOLS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482353724",
            "telephone_number": "131-416-6262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OWHOR",
        "first_name": "CLIFFORD",
        "middle_name": "N",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-04",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601002432",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MI",
            "license": "5601002432",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316135379",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.