NPIMap

Individual provider Active NPI

Teresa Altawil, AGPCNP-BC

  • Gerontology Nurse Practitioner
  • Southfield, MI
National Provider Identifier
1548937162
Registry record updated Oct 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
AG05210095 Issued in MI
Practice address
25130 Southfield Rd Ste 120
Southfield, MI 48075-1900
Phone
(248) 234-6799
NPI assigned
Aug 23, 2021
Last updated
Oct 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X AG05210095 MI Primary

Addresses

Primary practice location

25130 Southfield Rd Ste 120
Southfield, MI 48075-1900

Mailing address

20905 Knobs Hollow Dr
Macomb, MI 48044-6326
Phone (586) 567-5556

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210923000665 MI Practitioner - Nurse Practitioner 3476950197 Reassigns benefits to 1 organization
I20250721002687 NY Practitioner - Nurse Practitioner 3476950197 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hamid Sattar MD PCGroup PAC ID 9638350358, 10 clinicians

Practice addresses (Care Compare)

25130 Southfield Rd
Suite 120
Southfield, MI 48075-1900
Phone (248) 262-7120

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AG05210095MIMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hamid Sattar MD PC CurrentSince Aug 1, 2021 Accepting new patients
Victory Medical Associates PC CurrentSince May 20, 2025 Accepting new patients

Locations

25130 Southfield Rd
Ste 105
Southfield, MI 48075
Phone (248) 234-6790

25130 Southfield Rd
Ste 120
Southfield, MI 48075
Phone (248) 234-6790

129 W 110th St
New York, NY 10026
Phone (212) 662-3400

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761696000000",
    "number": "1548937162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20905 KNOBS HOLLOW DR",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480446326",
            "telephone_number": "586-567-5556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25130 SOUTHFIELD RD STE 120",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480751900",
            "telephone_number": "248-234-6799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALTAWIL",
        "first_name": "TERESA",
        "credential": "AGPCNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-23",
        "last_updated": "2025-10-29",
        "certification_date": "2025-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MI",
            "license": "AG05210095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.