NPIMap

Organization Active NPI

The Wellness Plan Medical Centers

Doing business as The Wellness Plan

  • Clinic/Center
  • Detroit, MI
National Provider Identifier
1669632816
Registry record updated Aug 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
THE WELLNESS PLAN MEDICAL CENTERS
Doing business as
The Wellness Plan
The Wellness Plan Medical Centers
Practice address
4909 E Outer Dr
Detroit, MI 48234-3446
Phone
(313) 366-2000
Fax
(313) 369-3950
NPI assigned
Jun 11, 2008
Last updated
Aug 13, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2020

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

Authorized official

Name
Anthony V King
Title
Ceo & Executive Director
Phone
(313) 202-8550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

4909 E Outer Dr
Detroit, MI 48234-3446

Mailing address

7700 2ND Ave
Detroit, MI 48202-2411
Phone (313) 202-8785

Other names 2

  • The Wellness Plan Doing business as
  • The Wellness Plan Medical Centers Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080603000231 MI Part A Provider - Federally Qualified Health Center (FQHC) 1052380201 1 other NPI on this enrollment
Practice locations: Detroit, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669632816. Details of each certification follow.

Federally qualified health center certification: CCN 231932

Legal name
THE WELLNESS PLAN MEDICAL CENTERS
Doing business as
THE WELLNESS PLAN MEDICAL CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 22, 2008
Last certification
Jul 22, 2008
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Nov 14, 1972 in MI
Enrollment address
4909 E Outer Dr
Detroit, MI 48234-3446

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Comprehensive Health SV10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Anthony V King Individual Corporate OfficerCeo and Executive Director Feb 12, 2007 100%
W-2 Managing Employee Feb 12, 2007
Daniell L Jones Individual Corporate Director Oct 18, 2010
Margaret L Betts Individual Corporate Director Dec 7, 2005
Mahasin N. Pierce Individual Corporate Director Jun 12, 2013
Larry Warren Individual Corporate Director May 14, 2014
Cassandra Willis-Abner Individual Corporate Director Jan 9, 2013
Anita Moncrease Individual Corporate Director Dec 7, 2005
Adrian Lewis Individual Corporate Director Jan 9, 2013
Betty Shelton Individual Corporate OfficerChief Administrative Officer May 1, 2016 50%
W-2 Managing EmployeeChief Administrative Officer May 1, 2016 50%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Wellness Plan Medical Center-PontiacPontiac, MI, CCN 231127 Federally qualified health center Operational/Managerial Control (100%) Jul 7, 2017

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1213142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597276800000",
    "number": "1669632816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7700 2ND AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022411",
            "telephone_number": "313-202-8785",
            "fax_number": "313-202-6870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4909 E OUTER DR",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482343446",
            "telephone_number": "313-366-2000",
            "fax_number": "313-369-3950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WELLNESS PLAN MEDICAL CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-11",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "CEO & EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "313-202-8550"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Wellness Plan",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Wellness Plan Medical Centers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Wellness Plan Medical Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.