Active NPI
Debra Peven, DO
- Neurology Physician
- West Bloomfield, MI
National Provider Identifier
1629049879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- DP009646
- Practice address
- 6777 W Maple Rd
West Bloomfield, MI 48322-3013 - Phone
- (313) 916-2585
- Fax
- (313) 916-3014
- NPI assigned
- Jan 27, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | DP009646 | MI | Primary |
Addresses
Primary practice location
6777 W Maple Rd
West Bloomfield, MI 48322-3013
Mailing address
6777 W Maple Rd
West Bloomfield, MI 48322-3013
Phone (313) 916-2585
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 114651261 | Medicaid | MI | |
| 1356510065 | Other | MI | BLUE CROSS |
| 1012243 | Other | MI | MCLAREN |
| 1012243 | Other | HEALTH ADVANTAGE | |
| P00203101 | Other | MEDICARE RAILROAD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DP009646 | MI | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366934400000",
"number": "1629049879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6777 W MAPLE RD",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483223013",
"telephone_number": "313-916-2585",
"fax_number": "313-916-3014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6777 W MAPLE RD",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483223013",
"telephone_number": "313-916-2585",
"fax_number": "313-916-3014"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEVEN",
"first_name": "DEBRA",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-01-27",
"last_updated": "2013-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MI",
"license": "DP009646",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "114651261",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "1356510065",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCLAREN",
"identifier": "1012243",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ADVANTAGE",
"identifier": "1012243",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "P00203101",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in West Bloomfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.