NPIMap

Individual provider Active NPI

Dominic A Cusumano, MD

  • Internal Medicine Physician
  • Warren, MI
National Provider Identifier
1447243779
Registry record updated Dec 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301407063 Issued in MI
Practice address
28295 Schoenherr Rd
Ste C
Warren, MI 48088-4300
Phone
(586) 573-6669
Fax
(586) 573-6667
NPI assigned
Aug 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301407063 MI Primary

Addresses

Primary practice location

28295 Schoenherr Rd
Ste C
Warren, MI 48088-4300

Mailing address

28295 Schoenherr Rd
Ste C
Warren, MI 48088-4300
Phone (586) 573-6669

Other identifiers 1

IdentifierTypeStateIssuer
0E06364OtherMIBCBS

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address referrals@epimed.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040124000185 MI Practitioner - Internal Medicine 0446152953 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Wayne State University School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

8600 Chicago Rd
Warren, MI 48093-5546
Phone (586) 826-3300

Hospital & facility affiliations

  • Henry Ford Home Health Care Home health agency, Detroit, MI, CCN 237087
  • Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053
  • Henry Ford Macomb Hospital Hospital, Clinton Township, MI, CCN 230047
  • Henry Ford Health St John Hospital Hospital, Detroit, MI, CCN 230165

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health System Current Accepting new patients
Henry Ford Health System CurrentSince Apr 1, 2021 Accepting new patients
Henry Ford Health System Internal Medicine CurrentSince Apr 1, 2021 Accepting new patients
Henry Ford Maplegrove Center Past Accepting new patients

Locations

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

14500 Hall Rd
Sterling Hts, MI 48313
Phone (586) 247-2700

8600 Chicago Rd
Warren, MI 48093
Phone (586) 826-3300

Interoperability endpoints

  • Direct secure messaging: dcusumano57811@direct.hfhs.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609200000000",
    "number": "1447243779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28295 SCHOENHERR RD",
            "address_2": "STE C",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480884300",
            "telephone_number": "586-573-6669",
            "fax_number": "586-573-6667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28295 SCHOENHERR RD",
            "address_2": "STE C",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480884300",
            "telephone_number": "586-573-6669",
            "fax_number": "586-573-6667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUSUMANO",
        "first_name": "DOMINIC",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-23",
        "last_updated": "2020-12-29",
        "certification_date": "2020-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301407063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0E06364",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "referrals@epimed.net",
            "affiliation": "N",
            "address_1": "28295 Schoenherr Rd",
            "address_2": "Ste C",
            "city": "Warren",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480884300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

Verify at the official NPI Registry.