NPIMap

Organization Active NPI

The Wellness Plan Medical Centers

Doing business as The Henderson Clinic

  • Clinic/Center
  • Pontiac, MI
National Provider Identifier
1447675434
Registry record updated Feb 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
THE WELLNESS PLAN MEDICAL CENTERS
Doing business as
The Henderson Clinic
Practice address
44405 Woodward Ave
Suite H-13
Pontiac, MI 48341-5023
Phone
(248) 858-3126
Fax
(248) 858-6499
NPI assigned
Feb 27, 2014
Last updated
Feb 12, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2019

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

Authorized official

Name
Mr. Anthony V King
Title
Ceo and Executive Director
Phone
(313) 202-8550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

44405 Woodward Ave
Suite H-13
Pontiac, MI 48341-5023

Mailing address

7700 2ND Ave
Detroit, MI 48202-2411
Phone (313) 202-8660

Other names 1

  • The Henderson Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040925000098 MI Part B Supplier - Clinic/Group Practice 1052380201 Receives reassigned benefits from 46 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Detroit, MI; Oak Park, MI; Pontiac, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447675434. Details of each certification follow.

  • CCN 231032 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 231032

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
THE WELLNESS PLAN
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 3, 2014
Last certification
Jul 3, 2014
Ownership / control type
For profit – corporation
Facility address
44405 Woodward Ave, Suite H-13
Pontiac, MI 48341

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1393459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549929600000",
    "number": "1447675434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7700 2ND AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022411",
            "telephone_number": "313-202-8660",
            "fax_number": "313-202-8653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44405 WOODWARD AVE",
            "address_2": "SUITE H-13",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483415023",
            "telephone_number": "248-858-3126",
            "fax_number": "248-858-6499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WELLNESS PLAN MEDICAL CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-27",
        "last_updated": "2019-02-12",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "CEO AND EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "313-202-8550",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Henderson Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Henderson Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pontiac, MI

Sources for this page

Verify at the official NPI Registry.