Marjan Moghaddam, D.O

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5101019748 Issued in MI

Practice address

3370 E Jefferson Ave
Detroit, MI 48207-4236

Phone

(800) 659-6568

Fax

(313) 656-1610

NPI assigned

Jun 27, 2012

Reactivated

Nov 21, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Practice

Education

Michigan State University College of Osteopathic Medicine, 2012

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)

Hospital & facility affiliations

• Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: marjan.moghaddam.1@16555.direct.athenahealth.com

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.

• Henry Ford Health System

  • General Acute Care Hospital
  • Detroit, MI
  • NPI 1134144801
  Medicare reassignment Care Compare group NPD
• Henry Ford Wyandotte Hospital

  • Clinical Social Worker
  • Wyandotte, MI
  • NPI 1093940272
  Medicare reassignment NPD
• Henr Y Ford Health System

  • Family Medicine Physician
  • Detroit, MI
  • NPI 1952485351
  NPD
• Henry Ford Health System

  • Community/Retail Pharmacy
  • Plymouth, MI
  • NPI 1942931720
  NPD
• Henry Ford Pathology

  • Anatomic Pathology & Clinical Pathology Physician
  • Detroit, MI
  • NPI 1851410005
  NPD
• Henry Ford Wyandotte Hospital

  dba Henry Ford Health Center-Brownstown Pharmacy

  • Community/Retail Pharmacy
  • Brownstown TWP, MI
  • NPI 1356356984
  NPD
• Henry Ford Wyandotte Hospital

  • Family Medicine Physician
  • Allen Park, MI
  • NPI 1841564788
  NPD
• Henry Ford Health System

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1891702833
  NPD (past)
• Henry Ford Maplegrove Center

  dba Henry Ford Health System

  • Children's Substance Abuse Rehabilitation Facility
  • West Bloomfield, MI
  • NPI 1295767630
  NPD (past)

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

• Henry Ford Health System

  • General Acute Care Hospital
  • Detroit, MI
  • NPI 1134144801
  Care Compare affiliation

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

{
    "created_epoch": "1340755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615248000000",
    "number": "1457615247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4077 CROOKS RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480732481",
            "telephone_number": "248-595-2328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3370 E JEFFERSON AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482074236",
            "telephone_number": "800-659-6568",
            "fax_number": "313-656-1610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOGHADDAM",
        "first_name": "MARJAN",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-27",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "deactivation_date": "2018-10-22",
        "reactivation_date": "2018-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101019748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmoghaddam595126@direct.hfhs.org",
            "affiliation": "N",
            "address_1": "3370 E Jefferson Ave",
            "city": "Detroit",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482074236",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Anzor Modzgvreschvili, RD
• Kelsie Marie Moeller, DO
• Kristen Moerchen
• Savannah Rose Moffat
• Kirsten I Mogbo, MD
• Lylas G. Mogk, M.D.
• Bashar Nasour Mohamad, MD
• Tamam Mohamad
• Mohamed Moctar Mohamed Moctar
• Aayah Mohamed-Osman, DO

• Family Medicine Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.