Active NPI
Edgar Jose Paz Concho
- Student in an Organized Health Care Education/Training Program
- Detroit, MI
National Provider Identifier
1376221697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 4351051494
- Practice address
- 3990 John R St
Detroit, MI 48201-2018 - Phone
- (313) 745-7233
- NPI assigned
- Jul 6, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 4351051494 | MI | Primary |
Addresses
Primary practice location
3990 John R St
Detroit, MI 48201-2018
Mailing address
3212 Woodland Ave
Royal Oak, MI 48073-2358
Phone (248) 321-2209
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230711003871 | MI | Order and Referring Only - Anesthesiology | 9931568706 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4351051494 | MI | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1688601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688601600000",
"number": "1376221697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3212 WOODLAND AVE",
"city": "ROYAL OAK",
"state": "MI",
"postal_code": "480732358",
"telephone_number": "248-321-2209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3990 JOHN R ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012018",
"telephone_number": "313-745-7233"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAZ CONCHO",
"first_name": "EDGAR",
"middle_name": "JOSE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-07-06",
"last_updated": "2023-07-06",
"certification_date": "2023-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MI",
"license": "4351051494",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Jul 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.