NPIMap

Organization Active NPI

Pennview Medical Clinic,Inc.

  • Preferred Provider Organization
  • Riverview, MI
National Provider Identifier
1386846160
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
035652 Issued in MI
Legal business name
PENNVIEW MEDICAL CLINIC,INC.
Practice address
12611 Pennsylvania Rd
Riverview, MI 48193-4224
Phone
(734) 285-5280
Fax
(734) 285-6730
NPI assigned
Jun 4, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Ashwin N Raval, MDNPI 1558369132
Title
Doctor
Phone
(734) 285-5280

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
Preferred Provider Organization 305R00000X 035652 MI Primary

Addresses

Primary practice location

12611 Pennsylvania Rd
Riverview, MI 48193-4224

Mailing address

12611 Pennsylvania Rd
Riverview, MI 48193-4224
Phone (734) 285-5280

National Provider Directory

National Provider Directory

Locations

12611 Pennsylvania Rd
Riverview, MI 48193
Phone (734) 285-5280

Practitioners & affiliated clinicians

Practitioners 5

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": "1180915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386846160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12611 PENNSYLVANIA RD",
            "city": "RIVERVIEW",
            "state": "MI",
            "postal_code": "481934224",
            "telephone_number": "734-285-5280",
            "fax_number": "734-285-6730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12611 PENNSYLVANIA RD",
            "city": "RIVERVIEW",
            "state": "MI",
            "postal_code": "481934224",
            "telephone_number": "734-285-5280",
            "fax_number": "734-285-6730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNVIEW MEDICAL CLINIC,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RAVAL",
        "authorized_official_first_name": "ASHWIN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "734-285-5280",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "MI",
            "license": "035652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverview, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.