Henry Ford Macomb Ancillary Services

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

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

Jan 9, 2015

Last updated

Mar 3, 2015By the provider in NPPES

Organization subpart

Yes

Parent organization

HENRY FORD MACOMB HOSPITAL CORPORATIONAs reported in NPPES

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 2

Addresses

Other names 1

• HENRY FORD MACOMB IMAGING CENTER-MT. CLEMENS Other name

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Henry Ford Macomb Ancillary Services

  • Clinical Medical Laboratory
  • Mount Clemens, MI
  • NPI 1669864708

  O20150420001928

  Same enrollment

Tax ID family

Henry Ford Macomb Services2 organizations share this tax ID, including this one

Part of

Psychiatric Physicians

Other organizations with this tax ID 1

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

• Henry Ford Macomb Ancillary Services

  • Clinical Medical Laboratory
  • Mount Clemens, MI
  • NPI 1669864708
  NPD tax ID

Practitioners 2

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.

• Anthony P Munaco, M.D.

  • Diagnostic Radiology Physician
  • Clinton Township, MI
  • NPI 1134108368
  NPD
• David Paul Schmittou III

  • Internal Medicine Physician
  • Mount Clemens, MI
  • NPI 1972064301
  NPD

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

{
    "created_epoch": "1420761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425340800000",
    "number": "1689062911",
    "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": "2015-01-09",
        "last_updated": "2015-03-03",
        "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": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HENRY FORD MACOMB IMAGING CENTER-MT. CLEMENS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• David Lawrence Hayter, PH.D
• Healing Conversations LLC
• Tifanie N Heard, MA, LLPC
• Arthur L Henderson, CPRM,CPRC
• Henry Ford Macomb Ancillary Services
• Henry Ford Macomb Hospital Corporation (Henry Ford Macomb Hospital - Mt. Clemens Campus)
• Henry Ford Macomb Hospital Corporation
• Henry Ford Macomb Hospital Corporation (Henry Ford Macomb Hospital - Mt. Clemens Campus)
• Henry Ford Macomb Hospital Corporation (Henry Ford Macomb Hospital)
• Henry Ford Macomb Hospital Corporation (Henry Ford Macomb Home Health Services)

• Radiology Clinic/Center in Mount Clemens, MI
• Providers in Mount Clemens, MI by specialty
• Radiology Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.