NPIMap

Organization Active NPI

Elias H Kassab MD PLLC

Doing business as Dearborn Cardiology

  • Interventional Cardiology Physician
  • Dearborn, MI
National Provider Identifier
1437585106
Registry record updated Jan 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
4301047006 Issued in MI
Legal business name
ELIAS H KASSAB MD PLLC
Doing business as
Dearborn Cardiology
Practice address
5250 Auto Club Dr Ste 300
Dearborn, MI 48126-2619
Phone
(313) 724-9000
Fax
(313) 562-9300
NPI assigned
Sep 25, 2013
Last updated
Jan 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2022

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

Authorized official

Name
Elias H Kassab, MDNPI 1922076835
Title
Owner/President
Phone
(313) 724-9000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 4301047006 MI
Interventional Cardiology Physician 207RI0011X 4301047006 MI Primary

Addresses

Primary practice location

5250 Auto Club Dr Ste 300
Dearborn, MI 48126-2619

Mailing address

1360 Porter St
Suite 100
Dearborn, MI 48124-2823
Phone (313) 724-9000

Other practice location 1

9025 Pardee Rd
Taylor, MI 48180-2755
Phone (313) 724-9000

Other practice location 2

645 Barclay Cir
Rochester Hills, MI 48307-5804
Phone (248) 844-1010

Other practice location 3

1695 12 Mile Rd
Berkley, MI 48072-2182
Phone (248) 307-7275

Other identifiers 1

IdentifierTypeStateIssuer
1437585106MedicaidMI

Other names 1

  • Dearborn Cardiology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140128000554 MI Part B Supplier - Clinic/Group Practice 8123257987 Receives reassigned benefits from 13 practitioners
Practice locations: Dearborn, MI; Detroit, MI; Garden City, MI

National Provider Directory

National Provider Directory

Locations

5250 Auto Club Dr
Ste 310
Dearborn, MI 48126

4201 Saint Antoine St
Ste 6B1
Detroit, MI 48201
Phone (313) 495-7200

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1380067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641945600000",
    "number": "1437585106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1360 PORTER ST",
            "address_2": "SUITE 100",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242823",
            "telephone_number": "313-724-9000",
            "fax_number": "313-562-9300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5250 AUTO CLUB DR STE 300",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262619",
            "telephone_number": "313-724-9000",
            "fax_number": "313-562-9300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9025 Pardee Rd",
            "address_purpose": "LOCATION",
            "city": "Taylor",
            "state": "MI",
            "postal_code": "481802755",
            "country_code": "US",
            "telephone_number": "313-724-9000",
            "fax_number": "313-562-9300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "645 Barclay Cir",
            "address_purpose": "LOCATION",
            "city": "Rochester Hills",
            "state": "MI",
            "postal_code": "483075804",
            "country_code": "US",
            "telephone_number": "248-844-1010",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1695 12 Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Berkley",
            "state": "MI",
            "postal_code": "480722182",
            "country_code": "US",
            "telephone_number": "248-307-7275",
            "fax_number": "248-307-7701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ELIAS H KASSAB MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-25",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A",
        "authorized_official_last_name": "KASSAB",
        "authorized_official_first_name": "ELIAS",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "313-724-9000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": "4301047006",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MI",
            "license": "4301047006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1437585106",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dearborn Cardiology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dearborn Cardiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dearborn, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; 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.