NPIMap

Organization Active NPI

University Physician Group

Doing business as Wayne State University Physician Group

  • Counselor
  • Detroit, MI
National Provider Identifier
1447465661
Registry record updated Oct 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Legal business name
UNIVERSITY PHYSICIAN GROUP
Doing business as
Wayne State University Physician Group
Practice address
3901 Chrysler Dr
Tolan Park
Detroit, MI 48201-2167
Phone
(313) 993-3434
Fax
(313) 993-3421
NPI assigned
May 11, 2007
Last updated
Oct 26, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2016

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

Authorized official

Name
Mr. Jeffery P Kohlitz
Title
Chief Financial Officer
Phone
(248) 581-5930

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X NU Primary
Clinical Neuropsychologist 103G00000X NU
Psychologist 103T00000X NU
Social Worker 104100000X NU
Marriage & Family Therapist 106H00000X NU
Registered Nurse 163W00000X NU
Psychiatry Physician 2084P0800X NU

Addresses

Primary practice location

3901 Chrysler Dr
Tolan Park
Detroit, MI 48201-2167

Mailing address

1560 E Maple Rd
Ste 400-Credentialing Dept.
Troy, MI 48083-1138
Phone (248) 581-5973

Other identifiers 10

IdentifierTypeStateIssuer
0H22830OtherMIBCBSM GROUP # - NP
0H22832OtherMIBCBSM GROUP # - MD/DO
0H22872OtherMIBCBSM GROUP # - SOCIAL WORKER
0P32050OtherMIMEDICARE GROUP # - SOCIAL WORKER
0P32180OtherMIMEDICARE GROUP # - NP
0H22874OtherMIBCBSM GROUP # - PSYCHOLOGIST/NEUROPSYCHOLOGIST
0P32060OtherMIMEDICARE GROUP # - PSYCHOLOGIST/NEUROPSYCHOLOGIST
0H22872OtherMIBCBSM GROUP#-SOCIAL WORKER
0P32120OtherMIMEDICARE GROUP # - MD/DO FEE LOCALITY 99
0P30630OtherMIMEDICARE GROUP # - MD/DO

Other names 1

  • Wayne State University Physician Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments
Opioid treatment program
Medicare-enrolled since May 12, 2020

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060419000518 MI Part B Supplier - Clinic/Group Practice 8628087681 Receives reassigned benefits from 755 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Detroit, MI; Farmington Hills, MI; Flint, MI; Highland Park, MI; Livonia, MI; Roseville, MI; Southfield, MI; Southgate, MI…
O20200901003086 MI Part B Supplier - Opioid Treatment Program (Otp) 8628087681 Practice locations: Detroit, MI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

3901 Chrysler Dr
Ste 1A
Detroit, MI 48201
Phone (313) 577-1396

1560 E Maple Rd
Ste 200
Troy, MI 48083
Phone (248) 581-5200

Practitioners & affiliated clinicians

Practitioners 213

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 213

NPI Registry JSON

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477440000000",
    "number": "1447465661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 E MAPLE RD",
            "address_2": "STE 400-CREDENTIALING DEPT.",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831138",
            "telephone_number": "248-581-5973",
            "fax_number": "248-581-5640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 CHRYSLER DR",
            "address_2": "TOLAN PARK",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012167",
            "telephone_number": "313-993-3434",
            "fax_number": "313-993-3421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY PHYSICIAN GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2016-10-26",
        "status": "A",
        "authorized_official_last_name": "KOHLITZ",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "248-581-5930",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM GROUP # - NP",
            "identifier": "0H22830",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM GROUP # - MD/DO",
            "identifier": "0H22832",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM GROUP # - SOCIAL WORKER",
            "identifier": "0H22872",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP # - SOCIAL WORKER",
            "identifier": "0P32050",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP # - NP",
            "identifier": "0P32180",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM GROUP # - PSYCHOLOGIST/NEUROPSYCHOLOGIST",
            "identifier": "0H22874",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP # - PSYCHOLOGIST/NEUROPSYCHOLOGIST",
            "identifier": "0P32060",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM GROUP#-SOCIAL WORKER",
            "identifier": "0H22872",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP # - MD/DO FEE LOCALITY 99",
            "identifier": "0P32120",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP # - MD/DO",
            "identifier": "0P30630",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wayne State University Physician Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 26, 2016; 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.