Organization Active NPI

Plexus Gastro PLLC

  • Gastroenterology Physician
  • Detroit, MI
National Provider Identifier
1518745017
Registry record updated Aug 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
PLEXUS GASTRO PLLC
Practice address
6501 Greenfield Rd
Detroit, MI 48228-4780
Phone
(313) 651-7053
Fax
(313) 435-0535
NPI assigned
Sep 18, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2025

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

Authorized official

Name
Regina G Hicks
Title
Credentialing Manager
Phone
(586) 489-9436

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

6501 Greenfield Rd
Detroit, MI 48228-4780

Mailing address

9025 Pardee Rd
Taylor, MI 48180-2755
Phone (313) 315-1422

Other practice location 1

23801 W Warren St
Dearborn Heights, MI 48127-2276
Phone (734) 578-4913

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231026002922 MI Part B Supplier - Clinic/Group Practice 9537515598 Receives reassigned benefits from 1 practitioner
Practice locations: Dearborn Heights, MI; Taylor, MI; Southfield, MI; Detroit, MI

National Provider Directory

National Provider Directory

Locations

6501 Greenfield Rd
Detroit, MI 48228
Phone (313) 281-2225

Practitioners & affiliated clinicians

Practitioners 1

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": "1694995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754697600000",
    "number": "1518745017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9025 PARDEE RD",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481802755",
            "telephone_number": "313-315-1422",
            "fax_number": "313-435-0535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6501 GREENFIELD RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482284780",
            "telephone_number": "313-651-7053",
            "fax_number": "313-435-0535"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "23801 W Warren St",
            "address_purpose": "LOCATION",
            "city": "Dearborn Heights",
            "state": "MI",
            "postal_code": "481272276",
            "country_code": "US",
            "telephone_number": "734-578-4913",
            "fax_number": "313-435-0535",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PLEXUS GASTRO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-18",
        "last_updated": "2025-08-09",
        "certification_date": "2025-08-09",
        "status": "A",
        "authorized_official_last_name": "HICKS",
        "authorized_official_first_name": "REGINA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "586-489-9436"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 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.