Individual provider Active NPI

Katterinne Hidalgo

  • Family Nurse Practitioner
  • Detroit, MI
National Provider Identifier
1376286393
Registry record updated Oct 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704319910 Issued in MI
Practice address
5635 W Fort St
Detroit, MI 48209-3154
Phone
(313) 849-3920
NPI assigned
Apr 18, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 4704319910 MI
Family Nurse Practitioner 363LF0000X 4704319910 MI Primary

Addresses

Primary practice location

5635 W Fort St
Detroit, MI 48209-3154

Mailing address

1 Ford PL Ste 3a
Detroit, MI 48202-3450
Phone (313) 874-4806

Other practice location 1

480 Waterbury Ct
Belleville, MI 48111-4928
Phone (734) 635-6014

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
I20221029000180 MI Practitioner - Nurse Practitioner 0648647966 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704319910MIMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health System CurrentSince Oct 27, 2022 Accepting new patients
Henry Ford Pathology Current Accepting new patients
Henry Ford Health System Family CurrentSince Oct 27, 2022 Accepting new patients
Henry Ford Maplegrove Center Past Accepting new patients
Community Health and Social Services Center, Inc Past Accepting new patients

Locations

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

1 Ford Pl
Ste 3A
Detroit, MI 48202
Phone (313) 874-2892

Interoperability endpoints

  • Direct secure messaging: khidalgo811060@direct.hfhs.org

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1650240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666828800000",
    "number": "1376286393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 FORD PL STE 3A",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023450",
            "telephone_number": "313-874-4806",
            "fax_number": "313-876-1305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5635 W FORT ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482093154",
            "telephone_number": "313-849-3920"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "480 Waterbury Ct",
            "address_purpose": "LOCATION",
            "city": "Belleville",
            "state": "MI",
            "postal_code": "481114928",
            "country_code": "US",
            "telephone_number": "734-635-6014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HIDALGO",
        "first_name": "KATTERINNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-18",
        "last_updated": "2022-10-27",
        "certification_date": "2022-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704319910",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704319910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.