Individual provider Active NPI

Racha Bazzi

  • Family Nurse Practitioner
  • Dearborn, MI
National Provider Identifier
1679274500
Registry record updated Mar 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F03230053 Issued in MI
Practice address
5728 Schaefer Rd Ste 103
Dearborn, MI 48126-2287
Phone
(313) 581-8080
Fax
(313) 581-8383
NPI assigned
Mar 16, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F03230053 MI Primary

Addresses

Primary practice location

5728 Schaefer Rd Ste 103
Dearborn, MI 48126-2287

Mailing address

5728 Schaefer Rd Ste 103
Dearborn, MI 48126-2287
Phone (313) 581-8080

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230725002444 MI Practitioner - Nurse Practitioner 5597126417 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F03230053MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prime Care Medical Clinic PLLC CurrentSince Jun 1, 2023 Accepting new patients

Locations

5728 Schaefer Rd
Ste 103
Dearborn, MI 48126
Phone (313) 581-8080

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BAIAAA

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1678924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1679274500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5728 SCHAEFER RD STE 103",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262287",
            "telephone_number": "313-581-8080",
            "fax_number": "313-581-8383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5728 SCHAEFER RD STE 103",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262287",
            "telephone_number": "313-581-8080",
            "fax_number": "313-581-8383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAZZI",
        "first_name": "RACHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-16",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "F03230053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.