NPIMap

Individual provider Active NPI

Dominic Carl Fano, D.O.

  • Family Medicine Physician
  • Mount Clemens, MI
National Provider Identifier
1316387491
Registry record updated Apr 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101020631 Issued in MI
Practice address
1000 Harrington Blvd.
Mount Clemens, MI 48043-2920
Phone
(586) 493-3727
NPI assigned
Jul 3, 2013
Last updated
Apr 12, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 12, 2021

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 5101020631 MI Primary

Addresses

Primary practice location

1000 Harrington Blvd.
Mount Clemens, MI 48043-2920

Mailing address

1000 Harrington Blvd.
Mount Clemens, MI 48043-2920
Phone (586) 493-3727

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dfano605427@direct.hfhs.org

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
I20150724011687 MI Practitioner - Family Practice 6002135795 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

2825 Livernois Rd
Troy, MI 48083-1214
Phone (248) 680-6000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health System Current Accepting new patients
Oxford Urgent Care P L C CurrentSince Jun 7, 2015 Accepting new patients
Lakeside Urgent Care, P. C. Current Accepting new patients
Lakeside Urgent Care, P.C. CurrentSince Jun 7, 2015 Accepting new patients
Henry Ford Health System CurrentSince Jun 25, 2019 Accepting new patients
Henr Y Ford Health System Family Medicine CurrentSince Jun 25, 2019 Accepting new patients
Henry Ford Maplegrove Center Past Accepting new patients

Locations

44472 Hayes Rd
Clinton Twp, MI 48038
Phone (586) 412-0890

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

72 S Washington St
Ste 102
Oxford, MI 48371
Phone (248) 236-8333

2825 Livernois Rd
Troy, MI 48083
Phone (248) 680-2060

Interoperability endpoints

  • Direct secure messaging: dfano605427@direct.hfhs.org

Organizations & group practices 7

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 4

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": "1372809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618185600000",
    "number": "1316387491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 HARRINGTON BLVD.",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432920",
            "telephone_number": "586-493-3727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HARRINGTON BLVD.",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432920",
            "telephone_number": "586-493-3727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANO",
        "first_name": "DOMINIC",
        "middle_name": "CARL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-07-03",
        "last_updated": "2021-04-12",
        "certification_date": "2021-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101020631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dfano605427@direct.hfhs.org",
            "affiliation": "N",
            "address_1": "2799 W Grand Blvd",
            "city": "Detroit",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482022608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mount Clemens, MI

Sources for this page

Verify at the official NPI Registry.