Mansour Mercy Medical Center PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

AM078660 Issued in MI

Legal business name

MANSOUR MERCY MEDICAL CENTER PLLC

Practice address

21321 Kelly Rd Ste 100
Eastpointe, MI 48021-3214

Phone

(586) 443-5580

Fax

(586) 443-5590

NPI assigned

Nov 1, 2006

Last updated

Oct 8, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alaa G Mansour, M.DNPI 1902896608

Title

Presadent

Phone

(586) 443-5580

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

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.

• Alaa G Mansour, M.D.

  • Family Medicine Physician
  • Eastpointe, MI
  • NPI 1902896608
  Medicare reassignment NPD Authorized official
• Joanna Hopkins, AGPCNP-BC

  • Nurse Practitioner
  • Troy, MI
  • NPI 1538864392
  Medicare reassignment NPD

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728345600000",
    "number": "1699852343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21321 KELLY RD STE 100",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "480213214",
            "telephone_number": "586-443-5580",
            "fax_number": "586-443-5590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21321 KELLY RD STE 100",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "480213214",
            "telephone_number": "586-443-5580",
            "fax_number": "586-443-5590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANSOUR MERCY MEDICAL CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-07",
        "status": "A",
        "authorized_official_last_name": "MANSOUR",
        "authorized_official_first_name": "ALAA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESADENT",
        "authorized_official_telephone_number": "586-443-5580",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "AM078660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1105015892",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4717292",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracy Denice Lowe
• Madison Community Hospital Inc (Samaritan Labs)
• Heather Christine Mahoney, LMSW-C
• Jacqueline Malinowski-Luck, LMSW, LMFT
• Mirko Malovic
• Alaa G Mansour, M.D.
• Marc J Steingold DDS
• Russell Marcilis II
• Tyler James Mariage, FNP-BC
• Rame Farah Marouf, D.D.S

• Family Medicine Physician in Eastpointe, MI
• Providers in Eastpointe, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; 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.