Individual provider Active NPI

Edgar Abuyan Altares, M.D.

  • Family Medicine Physician
  • Rochester Hills, MI
National Provider Identifier
1689745481
Registry record updated Oct 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301058048 Issued in MI
Practice address
1701 South Blvd E
Ste 150
Rochester Hills, MI 48307-6122
Phone
(248) 853-6300
Fax
(248) 853-6303
NPI assigned
Nov 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301058048 MI Primary

Addresses

Primary practice location

1701 South Blvd E
Ste 150
Rochester Hills, MI 48307-6122

Mailing address

1701 South Blvd E
Ste 270
Rochester Hills, MI 48307-6122
Phone (248) 853-2223

Other identifiers 2

IdentifierTypeStateIssuer
104860969MedicaidMI
0F32365OtherMIBCBS

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040721000163 MI Practitioner - Family Practice 1951381060 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

1 Ford PL
Detroit, MI 48202-3450
Phone (313) 874-6677

24725 Jefferson Ave
Saint Clair Shores, MI 48080-4500
Phone (586) 774-7800

2799 W Grand Blvd
Detroit, MI 48202-2608

Hospital & facility affiliations

  • Henry Ford Home Health Care Home health agency, Detroit, MI, CCN 237087
  • Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301058048MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henr Y Ford Health System Family Medicine CurrentSince Jun 1, 2015 Accepting new patients
Henry Ford Health System CurrentSince Jun 1, 2015 Accepting new patients
Henry Ford Health System Current Accepting new patients
New Image Home Medical Equipment Inc. PastSince Mar 28, 2017 Accepting new patients
Henry Ford Maplegrove Center Past Accepting new patients
Medical Services of Detroit PC Family Medicine Past Accepting new patients

Locations

1961 S Telegraph Rd
Bloomfield Township, MI 48302
Phone (248) 319-6190

19401 Hubbard Dr
Ste 207
Dearborn, MI 48126
Phone (313) 982-4444

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

24725 Jefferson Ave
St Clr Shores, MI 48080
Phone (586) 447-3680

22505 Allen Rd
Woodhaven, MI 48183
Phone (734) 671-6217

Interoperability endpoints

  • Direct secure messaging: ealtares366314@direct.hfhs.org

Organizations & group practices 6

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

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1255651200000",
    "number": "1689745481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 SOUTH BLVD E",
            "address_2": "STE 270",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483076122",
            "telephone_number": "248-853-2223",
            "fax_number": "248-853-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 SOUTH BLVD E",
            "address_2": "STE 150",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483076122",
            "telephone_number": "248-853-6300",
            "fax_number": "248-853-6303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALTARES",
        "first_name": "EDGAR",
        "middle_name": "ABUYAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2009-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301058048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104860969",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0F32365",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester Hills, MI

Sources for this page

Verify at the official NPI Registry.