NPIMap

Organization Active NPI

Amine P Amine MD PC

  • Adolescent Medicine (Internal Medicine) Physician
  • Saint Clair Shores, MI
National Provider Identifier
1376296434
Registry record updated Apr 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0000X
Legal business name
AMINE P AMINE MD PC
Practice address
22631 Greater Mack Ave Ste 100
Saint Clair Shores, MI 48080-2055
Phone
(586) 800-0086
Fax
(586) 800-0087
NPI assigned
Jan 30, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2023

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

Authorized official

Name
Mrs. Diana El Masri
Title
Billing Manager
Phone
(248) 215-0048

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RA0000X Primary

Addresses

Primary practice location

22631 Greater Mack Ave Ste 100
Saint Clair Shores, MI 48080-2055

Mailing address

PO Box 67
Royal Oak, MI 48068-0067

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220323000907 MI Part B Supplier - Clinic/Group Practice 5294120531 Receives reassigned benefits from 5 practitioners
Practice locations: Saint Clair Shores, MI

National Provider Directory

National Provider Directory

Locations

22745 Kelly Rd
Eastpointe, MI 48021
Phone (586) 771-1000

200 W 2nd St
Unit 67
Royal Oak, MI 48068

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1643500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681084800000",
    "number": "1376296434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 67",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480680067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22631 GREATER MACK AVE STE 100",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480802055",
            "telephone_number": "586-800-0086",
            "fax_number": "586-800-0087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMINE P AMINE MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-30",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-10",
        "status": "A",
        "authorized_official_last_name": "EL MASRI",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "248-215-0048",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RA0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2023; 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.