Southfield Premier Primary Care PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SOUTHFIELD PREMIER PRIMARY CARE PLLC

Practice address

17070 W 12 Mile Rd Ste a
Southfield, MI 48076-2116

Phone

(248) 559-2280

Fax

(248) 559-3752

NPI assigned

Jul 20, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Rafid Mansour, MDNPI 1265662308

Title

Medical Director/Physician

Phone

(248) 559-2280

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 1

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

• Rafid Y Mansour, M.D.

  • Internal Medicine Physician
  • Southfield, MI
  • NPI 1265662308
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1658275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658275200000",
    "number": "1417682766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17070 W 12 MILE RD STE A",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762116",
            "telephone_number": "248-559-2280",
            "fax_number": "248-559-3752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17070 W 12 MILE RD STE A",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762116",
            "telephone_number": "248-559-2280",
            "fax_number": "248-559-3752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHFIELD PREMIER PRIMARY CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-20",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A",
        "authorized_official_last_name": "MANSOUR",
        "authorized_official_first_name": "RAFID",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR/PHYSICIAN",
        "authorized_official_telephone_number": "248-559-2280",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Southfield Physical Therapy LLC
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• Southfield PT Inc
• Southfield Radiology Associates PLLC
• Southfield Regenerative Medical Center PLLC
• Southfield Rehab Center Inc

• Primary Care Clinic/Center in Southfield, MI
• Providers in Southfield, MI by specialty
• Primary Care Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.