NPIMap

Organization Active NPI

Health Centers Detroit Foundation, Inc.

Doing business as Health Centers Detroit Medical Group

  • Federally Qualified Health Center (FQHC)
  • Southfield, MI
National Provider Identifier
1386705804
Registry record updated Jan 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEALTH CENTERS DETROIT FOUNDATION, INC.
Doing business as
Health Centers Detroit Medical Group
Practice address
23077 Greenfield Rd Ste 489
Southfield, MI 48075-3740
Phone
(248) 423-3900
Fax
(248) 423-8169
NPI assigned
Dec 12, 2006
Last updated
Jan 20, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2012

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

Authorized official

Name
Dr. Herbert C. Smitherman Jr., M.D.NPI 1518905637
Title
President & Ceo
Phone
(313) 966-5187

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

23077 Greenfield Rd Ste 489
Southfield, MI 48075-3740

Mailing address

23077 Greenfield Rd Ste 489
Southfield, MI 48075-3740
Phone (248) 423-3900

Other names 1

  • Health Centers Detroit Medical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031204000807 MI Part B Supplier - Clinic/Group Practice 4284539081 Receives reassigned benefits from 13 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Detroit, MI; Southfield, MI
O20230120000958 MI Part A Provider - Federally Qualified Health Center (FQHC) 4284539081 Practice locations: Southfield, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386705804. Details of each certification follow.

Federally qualified health center certification: CCN C71002

Legal name
HEALTH CENTERS DETROIT FOUNDATION INC
Doing business as
HEALTH CENTERS DETROIT MEDICAL GROUP
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 19, 2022
Last certification
Dec 19, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 16, 2004 in MI
Enrollment address
23077 Greenfield Rd
Ste 400
Southfield, MI 48075-3740

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0371033Health Centers Detroit Medical Group23077 Greenfield Road Suite 400, Southfield, MI 48075Provider-performed microscopyJun 12, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Andrew Dignan Individual Corporate OfficerCao Jan 23, 2000
Victoria Nondabula Individual Corporate Director Jan 23, 2000
Eric W Ayers Individual Corporate Director Jan 23, 2000
Tiffany Brent Individual Corporate Director Jan 23, 2000
Rita D Canty Individual Corporate Director Jan 23, 2000
Richard P Wilson Individual Corporate Director Jan 23, 2000
Donna Doleman Individual Corporate Director Jan 23, 2000
Herbert Charles Smitherman Individual W-2 Managing Employee Nov 16, 2004
James Blessman Individual Corporate Director Jan 23, 2000

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327017600000",
    "number": "1386705804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23077 GREENFIELD RD STE 489",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480753740",
            "telephone_number": "248-423-3900",
            "fax_number": "248-423-8169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23077 GREENFIELD RD STE 489",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480753740",
            "telephone_number": "248-423-3900",
            "fax_number": "248-423-8169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH CENTERS DETROIT FOUNDATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2012-01-20",
        "status": "A",
        "authorized_official_last_name": "SMITHERMAN",
        "authorized_official_first_name": "HERBERT",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "313-966-5187",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health Centers Detroit Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.