Organization Active NPI

Heartfelt Physician Services, PLLC

  • General Practice Physician
  • Southfield, MI
National Provider Identifier
1578505129
Registry record updated Dec 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
4301407599 Issued in MI
Legal business name
HEARTFELT PHYSICIAN SERVICES, PLLC
Practice address
20245 W 12 Mile Rd
Ste 120
Southfield, MI 48076-5409
Phone
(248) 552-1327
Fax
(586) 859-5729
NPI assigned
Jun 11, 2006
Last updated
Dec 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2020

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

Authorized official

Name
Dr. Rebecca Kathleene Motley, MDNPI 1295782951
Title
President
Phone
(248) 552-1327

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X 4301407599 MI Primary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X

Addresses

Primary practice location

20245 W 12 Mile Rd
Ste 120
Southfield, MI 48076-5409

Mailing address

20245 W 12 Mile Rd
Ste 120
Southfield, MI 48076-5409
Phone (248) 552-1327

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070919000865 MI Part B Supplier - Clinic/Group Practice 9133213283 Receives reassigned benefits from 1 practitioner
Practice locations: Southfield, MI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D1064376Heartfelt Physician Services20245 W 12 Mile Road Suite 120, Southfield, MI 48076Certificate of waiverFeb 4, 2027

National Provider Directory

National Provider Directory

Locations

20245 W 12 Mile Rd
Ste 120
Southfield, MI 48076
Phone (248) 552-1327

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": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608249600000",
    "number": "1578505129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20245 W 12 MILE RD",
            "address_2": "STE 120",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480765409",
            "telephone_number": "248-552-1327",
            "fax_number": "586-859-5729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20245 W 12 MILE RD",
            "address_2": "STE 120",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480765409",
            "telephone_number": "248-552-1327",
            "fax_number": "586-859-5729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTFELT PHYSICIAN SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "status": "A",
        "authorized_official_last_name": "MOTLEY",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "KATHLEENE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-552-1327",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "MI",
            "license": "4301407599",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.