NPIMap

Organization Active NPI

Nursing Practice Corporation

Doing business as Taylor Street Primary Care Clinic

  • Nurse Practitioner
  • Detroit, MI
National Provider Identifier
1629616511
Registry record updated Dec 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
NURSING PRACTICE CORPORATION
Doing business as
Taylor Street Primary Care Clinic
Practice address
1550 Taylor St
Detroit, MI 48206-2081
Phone
(313) 577-5041
NPI assigned
Dec 11, 2019
Last updated
Dec 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2019

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

Authorized official

Name
Gloria SmithNPI 1124192174
Title
Chief Nursing Officer
Phone
(313) 577-5118

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU Primary

Addresses

Primary practice location

1550 Taylor St
Detroit, MI 48206-2081

Mailing address

5285 Anthony Wayne Dr
Detroit, MI 48202-3947
Phone (313) 577-5041

Other names 1

  • Taylor Street Primary Care Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070123000218 MI Part B Supplier - Clinic/Group Practice 5395746143 Receives reassigned benefits from 4 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Detroit, MI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
23D2178154Taylor Street Primary Care Clinic1550 Taylor Street, Detroit, MI 48206Provider-performed microscopyMar 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
Nursing Practice Corporation2 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.

Locations

1550 Taylor St
Detroit, MI 48206
Phone (313) 486-5501

5200 Anthony Wayne Dr
Apt 115
Detroit, MI 48202
Phone (313) 577-5041

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1576022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576022400000",
    "number": "1629616511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5285 ANTHONY WAYNE DR",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023947",
            "telephone_number": "313-577-5041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 TAYLOR ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482062081",
            "telephone_number": "313-577-5041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NURSING PRACTICE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-11",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_title_or_position": "CHIEF NURSING OFFICER",
        "authorized_official_telephone_number": "313-577-5118"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Taylor Street Primary Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 11, 2019; 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.