NPIMap

Organization Active NPI

Michigan Premier Geriatrics PLLC

  • Internal Medicine Physician
  • Southfield, MI
National Provider Identifier
1356779391
Registry record updated Oct 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301060202 Issued in MI
Legal business name
MICHIGAN PREMIER GERIATRICS PLLC
Practice address
29877 Telegraph Rd
Suite 200
Southfield, MI 48034-7659
Phone
(248) 354-0730
Fax
(248) 354-1652
NPI assigned
Oct 30, 2013
Last updated
Oct 30, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2013

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

Authorized official

Name
Dr. Fouad Batah, MDNPI 1285618983
Title
Owner
Phone
(248) 354-0730

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301060202 MI Primary

Addresses

Primary practice location

29877 Telegraph Rd
Suite 200
Southfield, MI 48034-7659

Mailing address

29877 Telegraph Road
Suite 200
Southfield, MI 48034-7659
Phone (248) 354-0730

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141006001337 MI Part B Supplier - Clinic/Group Practice 4284854704 Receives reassigned benefits from 11 practitioners
Practice locations: Bloomfield Hills, MI; West Bloomfield, MI; Southfield, MI; Royal Oak, MI; Detroit, MI

National Provider Directory

National Provider Directory

Locations

29877 Telegraph Rd
Ste 2
Southfield, MI 48034

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1383091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383091200000",
    "number": "1356779391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29877 TELEGRAPH ROAD",
            "address_2": "SUITE 200",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480347659",
            "telephone_number": "248-354-0730",
            "fax_number": "248-354-1652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29877 TELEGRAPH RD",
            "address_2": "SUITE 200",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480347659",
            "telephone_number": "248-354-0730",
            "fax_number": "248-354-1652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN PREMIER GERIATRICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-30",
        "last_updated": "2013-10-30",
        "status": "A",
        "authorized_official_last_name": "BATAH",
        "authorized_official_first_name": "FOUAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-354-0730",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301060202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.