Organization Active NPI

Trinity Medical Center, P.C.

  • Internal Medicine Physician
  • Sterling Heights, MI
National Provider Identifier
1730193657
Registry record updated Jan 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301070663 Issued in MI
Legal business name
TRINITY MEDICAL CENTER, P.C.
Practice address
37300 Dequindre Rd
Suite 120
Sterling Heights, MI 48310-3591
Phone
(586) 275-0065
Fax
(586) 275-0066
NPI assigned
Jul 28, 2006
Last updated
Jan 3, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2014

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

Authorized official

Name
Mr. Victor Petros Al-Matchy, M.D.NPI 1609811975
Title
Owner President
Phone
(586) 275-0065

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301070663 MI Primary

Addresses

Primary practice location

37300 Dequindre Rd
Suite 120
Sterling Heights, MI 48310-3591

Mailing address

37300 Dequindre Rd
Ste 120
Sterling Heights, MI 48310-3591
Phone (586) 275-0065

Other identifiers 3

IdentifierTypeStateIssuer
700E027480OtherMIBCBS
4301070663OtherMISTATE LICENSE
4889519 10MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060830000515 MI Part B Supplier - Clinic/Group Practice 8921002130 Receives reassigned benefits from 2 practitioners
Practice locations: Sterling Heights, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388707200000",
    "number": "1730193657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37300 DEQUINDRE RD",
            "address_2": "STE 120",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483103591",
            "telephone_number": "586-275-0065",
            "fax_number": "586-275-0066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37300 DEQUINDRE RD",
            "address_2": "SUITE 120",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483103591",
            "telephone_number": "586-275-0065",
            "fax_number": "586-275-0066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY MEDICAL CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2014-01-03",
        "status": "A",
        "authorized_official_last_name": "AL-MATCHY",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "PETROS",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "586-275-0065",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301070663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "700E027480",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "4301070663",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4889519 10",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sterling Heights, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2014; 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.