NPIMap

Organization Active NPI

Great Lakes Urgent Care PC of Eastside

  • Internal Medicine Physician
  • Eastpointe, MI
National Provider Identifier
1477978930
Registry record updated Mar 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4101093161 Issued in MI
Legal business name
GREAT LAKES URGENT CARE PC OF EASTSIDE
Practice address
19070 E 10 Mile Rd
Eastpointe, MI 48021-1449
Phone
(586) 773-1383
Fax
(586) 773-1385
NPI assigned
Feb 20, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2014

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

Authorized official

Name
Fuad M Rahimee, MD
Title
Medical Director
Phone
(586) 773-1383

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 4101093161 MI Primary

Addresses

Primary practice location

19070 E 10 Mile Rd
Eastpointe, MI 48021-1449

Mailing address

19070 E 10 Mile Rd
Eastpointe, MI 48021-1449
Phone (586) 773-1383

Other names 1

  • GLUCE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140508001412 MI Part B Supplier - Clinic/Group Practice 7810120235 Receives reassigned benefits from 7 practitioners
Practice locations: Eastpointe, MI

National Provider Directory

National Provider Directory
Tax ID family
Gluce2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 7

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": "1392854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395273600000",
    "number": "1477978930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19070 E 10 MILE RD",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "480211449",
            "telephone_number": "586-773-1383",
            "fax_number": "586-773-1385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19070 E 10 MILE RD",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "480211449",
            "telephone_number": "586-773-1383",
            "fax_number": "586-773-1385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES URGENT CARE PC OF EASTSIDE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-20",
        "last_updated": "2014-03-20",
        "status": "A",
        "authorized_official_last_name": "RAHIMEE",
        "authorized_official_first_name": "FUAD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "586-773-1383",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4101093161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GLUCE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eastpointe, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2014; 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.