NPIMap

Organization Active NPI

Grace University Medical Group

  • Internal Medicine Physician
  • Detroit, MI
National Provider Identifier
1447215538
Registry record updated Sep 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
GRACE UNIVERSITY MEDICAL GROUP
Practice address
6071 W Outer Dr
Dept of Medicine 4TH Floor
Detroit, MI 48235-2624
Phone
(313) 966-4946
NPI assigned
Apr 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2007

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

Authorized official

Name
Kenneth Bergsman, MD
Title
Manager
Phone
(313) 966-4946

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Hematology & Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RH0003X 4301028293 MI

Addresses

Primary practice location

6071 W Outer Dr
Dept of Medicine 4TH Floor
Detroit, MI 48235-2624

Mailing address

PO Box 321061
Detroit, MI 48232-1061
Phone (248) 543-8070

National Provider Directory

National Provider Directory

Locations

22341 W 8 Mile Rd
Detroit, MI 48219
Phone (313) 326-4989

6071 W Outer Dr
Ste 114
Detroit, MI 48235

14800 W McNichols Rd
Ste 1
Detroit, MI 48235

9857 N Haggerty Rd
Plymouth, MI 48170
Phone (248) 462-6588

306 S Washington Ave
Ste 201
Royal Oak, MI 48067

Practitioners & affiliated clinicians

Practitioners 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190160000000",
    "number": "1447215538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 321061",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482321061",
            "telephone_number": "248-543-8070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6071 W OUTER DR",
            "address_2": "DEPT OF MEDICINE 4TH FLOOR",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482352624",
            "telephone_number": "313-966-4946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE UNIVERSITY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2007-09-19",
        "status": "A",
        "authorized_official_last_name": "BERGSMAN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "313-966-4946",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MI",
            "license": "4301028293",
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Sep 19, 2007; 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.