NPIMap

Organization Active NPI

Halo Primary Care

  • Family Medicine Physician
  • Detroit, MI
National Provider Identifier
1386101293
Registry record updated Mar 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
HALO PRIMARY CARE
Practice address
1535 E State Fair
Detroit, MI 48203-1257
Phone
(313) 891-2740
NPI assigned
Feb 27, 2019
Organization subpart
Yes
Parent organization
HALO MEDICAL GROUP PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 5, 2019

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

Authorized official

Name
Hanady Beydoun
Title
Office Manager
Phone
(313) 993-7777

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1535 E State Fair
Detroit, MI 48203-1257

Mailing address

22720 Michigan Ave Ste 200
Dearborn, MI 48124-2021
Phone (313) 891-2740

Other identifiers 3

IdentifierTypeStateIssuer
14264493OtherCAQH
12715957OtherCAQH
1417245721MedicaidMI

National Provider Directory

National Provider Directory
Tax ID family
Halo Primary Care6 organizations share this tax ID, including this one
Part of
Halo Primary Care

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1551225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551744000000",
    "number": "1386101293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22720 MICHIGAN AVE STE 200",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242021",
            "telephone_number": "313-891-2740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1535 E STATE FAIR",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482031257",
            "telephone_number": "313-891-2740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HALO PRIMARY CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HALO MEDICAL GROUP PLLC",
        "enumeration_date": "2019-02-27",
        "last_updated": "2019-03-05",
        "status": "A",
        "authorized_official_last_name": "BEYDOUN",
        "authorized_official_first_name": "HANADY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "313-993-7777"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "14264493",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12715957",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417245721",
            "state": "MI"
        }
    ],
    "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 Mar 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.