Individual provider Active NPI

Saeedeh Elahi

  • Family Nurse Practitioner
  • Dearborn, MI
National Provider Identifier
1457705139
Registry record updated Apr 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704288150 Issued in MI
Practice address
12940 W Warren Ave
Dearborn, MI 48126-1535
Phone
(313) 945-8210
Fax
(313) 945-0720
NPI assigned
Apr 19, 2016
Last updated
Apr 19, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704288150 MI Primary

Addresses

Primary practice location

12940 W Warren Ave
Dearborn, MI 48126-1535

Mailing address

12940 W Warren Ave
Dearborn, MI 48126-1535
Phone (313) 945-8210

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180927003082 MI Practitioner - Nurse Practitioner 0345591467 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
4704288150MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tarif Mustafa MD PC CurrentSince Sep 2, 2022 Accepting new patients
Millennium Medical Group South PC PastSince Sep 2, 2022 Accepting new patients

Locations

12940 W Warren Ave
Dearborn, MI 48126
Phone (313) 945-8210

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1461024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461024000000",
    "number": "1457705139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12940 W WARREN AVE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481261535",
            "telephone_number": "313-945-8210",
            "fax_number": "313-945-0720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12940 W WARREN AVE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481261535",
            "telephone_number": "313-945-8210",
            "fax_number": "313-945-0720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELAHI",
        "first_name": "SAEEDEH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-19",
        "last_updated": "2016-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704288150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.