Individual provider Active NPI

Hoodo Mohamed, PA-C

  • Physician Assistant
  • Detroit, MI
National Provider Identifier
1366489106
Registry record updated Mar 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601004568 Issued in MI
Practice address
4201 Saint Antoine St
Suite 3R
Detroit, MI 48201-2153
Phone
(313) 745-3000
NPI assigned
Jun 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601004568 MI Primary

Addresses

Primary practice location

4201 Saint Antoine St
Suite 3R
Detroit, MI 48201-2153

Mailing address

4266 Hackberry CT
Ypsilanti, MI 48197-7540

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
I20051107000518 MI Practitioner - Physician Assistant 1153349378 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Huron Urgent Care Center PLCGroup PAC ID 6901086859, 5 clinicians
Epmg of Michigan PCGroup PAC ID 4789596339, 108 clinicians

Practice addresses (Care Compare)

1649 S Huron St
Ypsilanti, MI 48197-9701
Phone (734) 480-0990

5301 McAuley Dr
Ypsilanti, MI 48197-1051
Phone (954) 939-5000

775 S Main St
Chelsea, MI 48118-1383
Phone (954) 939-5000

Hospital & facility affiliations

  • Trinity Health Ann Arbor Hospital Hospital, Ann Arbor, MI, CCN 230156

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601004568MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Chelsea Community Hospital CurrentSince Jun 1, 2021 Accepting new patients
St Joseph Mercy Hospital CurrentSince Apr 22, 2014 Accepting new patients

Locations

1600 S Canton Center Rd
Canton, MI 48188
Phone (734) 398-7557

775 S Main St
Chelsea, MI 48118
Phone (313) 995-3764

111 N Huron St
Ste 203
Ypsilanti, MI 48197
Phone (734) 480-0033

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427760000000",
    "number": "1366489106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4266 HACKBERRY CT",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481977540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 SAINT ANTOINE ST",
            "address_2": "SUITE 3R",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012153",
            "telephone_number": "313-745-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHAMED",
        "first_name": "HOODO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-01",
        "last_updated": "2015-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.