Organization Active NPI

Downriver Endocrinology PLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Southgate, MI
National Provider Identifier
1467727420
Registry record updated Jan 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
4301046311 Issued in MI
Legal business name
DOWNRIVER ENDOCRINOLOGY PLC
Practice address
15125 Northline Rd
Southgate, MI 48195-2409
Phone
(734) 407-2311
Fax
(734) 282-1969
NPI assigned
Mar 9, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2025

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

Authorized official

Name
Nadia KhouryNPI 1346446143
Title
Practice Manager
Phone
(734) 282-3138

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RE0101X 4301046311 MI Primary

Addresses

Primary practice location

15125 Northline Rd
Southgate, MI 48195-2409

Mailing address

15125 Northline Rd
Southgate, MI 48195-2409
Phone (734) 282-3138

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120720000352 MI Part B Supplier - Clinic/Group Practice 8123284007 Receives reassigned benefits from 2 practitioners
Practice locations: Southgate, MI

National Provider Directory

National Provider Directory

Locations

15125 Northline Rd
Southgate, MI 48195
Phone (734) 282-3138

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1331251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737763200000",
    "number": "1467727420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15125 NORTHLINE RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952409",
            "telephone_number": "734-282-3138",
            "fax_number": "734-282-1969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15125 NORTHLINE RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952409",
            "telephone_number": "734-407-2311",
            "fax_number": "734-282-1969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOWNRIVER ENDOCRINOLOGY PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-09",
        "last_updated": "2025-01-25",
        "certification_date": "2025-01-25",
        "status": "A",
        "authorized_official_last_name": "KHOURY",
        "authorized_official_first_name": "NADIA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "734-282-3138"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MI",
            "license": "4301046311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southgate, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2025; 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.