NPIMap

Organization Active NPI

Henry Ford Macomb Ancillary Services

  • Clinical Medical Laboratory
  • Mount Clemens, MI
National Provider Identifier
1669864708
Registry record updated Mar 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
HENRY FORD MACOMB ANCILLARY SERVICES
Practice address
133 S Main St
Mount Clemens, MI 48043-2308
Phone
(586) 468-1600
Fax
(586) 465-0329
NPI assigned
Feb 26, 2015
Last updated
Mar 4, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
HENRY FORD MACOMB HOSPITAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 4, 2015

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

Authorized official

Name
Terry Goodbalian
Title
VP Finance & Cfo Hfmacomb
Phone
(586) 263-2705

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

133 S Main St
Mount Clemens, MI 48043-2308

Mailing address

15855 19 Mile Rd
Attn: Terry Goodbalian
Clinton Township, MI 48038-3504

Other names 1

  • HENRY FORD MACOMB LAB SERVICES-MT. CLEMENS Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150420001928 MI Part B Supplier - Clinic/Group Practice 6305164500 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
Practice locations: Clinton Township, MI; Mount Clemens, MI
O20160308002426 MI Part B Supplier - Independent Clinical Laboratory 6305164500 Practice locations: Mount Clemens, 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
23D0363718Henry Ford Macomb Ancillary Services133 S Main Street, Mount Clemens, MI 48043AccreditationDec 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Henry Ford Ancil Services2 organizations share this tax ID, including this one
Part of
Inpt Psychiatric Phys

Other organizations with this tax ID 1

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

133 S Main St
Ste A
Mount Clemens, MI 48043

Practitioners & affiliated clinicians

Practitioners 102

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 102

NPI Registry JSON

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

{
    "created_epoch": "1424908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425427200000",
    "number": "1669864708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15855 19 MILE RD",
            "address_2": "ATTN: TERRY GOODBALIAN",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480383504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 S MAIN ST",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432308",
            "telephone_number": "586-468-1600",
            "fax_number": "586-465-0329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENRY FORD MACOMB ANCILLARY SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HENRY FORD MACOMB HOSPITAL CORPORATION",
        "enumeration_date": "2015-02-26",
        "last_updated": "2015-03-04",
        "status": "A",
        "authorized_official_last_name": "GOODBALIAN",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "VP FINANCE & CFO HFMACOMB",
        "authorized_official_telephone_number": "586-263-2705"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HENRY FORD MACOMB LAB SERVICES-MT. CLEMENS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mount Clemens, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2015; 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.