NPIMap

Organization Active NPI

Dedicated Physicians Group of Michigan PLLC

Doing business as Dedicated Senior Medical Center Detroit East

  • Non-Pharmacy Dispensing Site
  • Detroit, MI
National Provider Identifier
1366028730
Registry record updated Mar 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
DEDICATED PHYSICIANS GROUP OF MICHIGAN PLLC
Doing business as
Dedicated Senior Medical Center Detroit East
Practice address
13210 E Jefferson Ave
Detroit, MI 48215-2704
Phone
(313) 335-3444
NPI assigned
Mar 24, 2021
Last updated
Mar 24, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
DEDICATED PHYSICIANS GROUP OF MICHIGAN PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 24, 2021

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

Authorized official

Name
Mary Chen
Title
Executive Officer
Phone
(305) 628-6117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

13210 E Jefferson Ave
Detroit, MI 48215-2704

Mailing address

1395 NW 167TH St
Miami Gardens, FL 33169-5710
Phone (305) 628-6117

Other names 1

  • Dedicated Senior Medical Center Detroit East Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2228618Dedicated Senior Medical Center - Detroit East13210 East Jefferson, Detroit, MI 48215Certificate of waiverJun 28, 2027

National Provider Directory

National Provider Directory
Tax ID family
Dedicated Physicians Group of Michigan PLLC6 organizations share this tax ID, including this one
Part of
Dedicated Physicians Group of Michigan PLLC

Other organizations with this tax ID 5

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

Locations

13210 E Jefferson Ave
Detroit, MI 48215
Phone (313) 335-3444

Practitioners & affiliated clinicians

Practitioners 59

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 59

NPI Registry JSON

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

{
    "created_epoch": "1616544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616544000000",
    "number": "1366028730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331695710",
            "telephone_number": "305-628-6117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13210 E JEFFERSON AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482152704",
            "telephone_number": "313-335-3444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEDICATED PHYSICIANS GROUP OF MICHIGAN PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEDICATED PHYSICIANS GROUP OF MICHIGAN PLLC",
        "enumeration_date": "2021-03-24",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A",
        "authorized_official_last_name": "CHEN",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "305-628-6117"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dedicated Senior Medical Center Detroit East",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.