NPIMap

Organization Active NPI

Oakwood Healthcare, Inc.

Doing business as Beaumont Hospital - Dearborn

  • Diagnostic Radiology Physician
  • Dearborn, MI
National Provider Identifier
1336174440
Registry record updated Jul 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
820120 Issued in MI
Legal business name
OAKWOOD HEALTHCARE, INC.
Doing business as
Beaumont Hospital - Dearborn
Practice address
18101 Oakwood Blvd
Dearborn, MI 48124-4089
Phone
(313) 593-7000
Fax
(313) 436-2038
NPI assigned
Jul 11, 2006
Last updated
Jul 11, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
OAKWOOD HEALTHCARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 11, 2022

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

Authorized official

Name
Lee Ann Odom
Title
President Shared Services
Phone
(947) 522-3338

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 820120 MI Primary

Addresses

Primary practice location

18101 Oakwood Blvd
Dearborn, MI 48124-4089

Mailing address

26901 Beaumont Blvd.
Compliance
Southfield, MI 48033-4716
Phone (947) 522-1963

Other identifiers 5

IdentifierTypeStateIssuer
000000002105OtherMICAPE HEALTH PROF PROV #
101577115MedicaidMI
OK20001OtherMIM-CARE PROFESSIONAL PROV#
060024539OtherMIRAILROAD PROF PROV #
0H26396OtherMIBC PROFESSIONAL PROV #

Other names 1

  • Beaumont Hospital - Dearborn Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.beaumont.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031205000505 MI Part B Supplier - Clinic/Group Practice 1254236839 Receives reassigned benefits from 33 practitioners
4 other NPIs on this enrollment
Practice locations: Dearborn, MI; Taylor, MI; Trenton, MI; Wayne, MI

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Oakwood Hospmed Ctr28 organizations share this tax ID, including this one
Part of
Oakwood Hospmed Ctr

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

Locations

16305 Sand Canyon Ave
Ste 255
Irvine, CA 92618
Phone (949) 443-4303

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Vibra Hospital of Southeastern Michigan - Taylor CampusTaylor, MI, CCN 232019 Hospital 5% Or Greater Direct Ownership Interest Apr 16, 2019
Corewell Health Rehabilitation & Nursing Center-Commons DearbornDearborn, MI, CCN 235502 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jan 24, 1985
Jan 24, 1985

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657497600000",
    "number": "1336174440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD.",
            "address_2": "COMPLIANCE",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480334716",
            "telephone_number": "947-522-1963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18101 OAKWOOD BLVD",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481244089",
            "telephone_number": "313-593-7000",
            "fax_number": "313-436-2038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAKWOOD HEALTHCARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OAKWOOD HEALTHCARE, INC.",
        "enumeration_date": "2006-07-11",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A",
        "authorized_official_last_name": "ODOM",
        "authorized_official_first_name": "LEE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT SHARED SERVICES",
        "authorized_official_telephone_number": "947-522-3338"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "820120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPE HEALTH PROF PROV #",
            "identifier": "000000002105",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101577115",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "M-CARE PROFESSIONAL PROV#",
            "identifier": "OK20001",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD PROF PROV #",
            "identifier": "060024539",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC  PROFESSIONAL PROV #",
            "identifier": "0H26396",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "18101 Oakwood Blvd",
            "city": "Dearborn",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481244089",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Beaumont Hospital - Dearborn",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beaumont Hospital - Dearborn",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.