NPIMap

Organization Active NPI

Dedicated Physicians Group of Michigan PLLC

  • Non-Pharmacy Dispensing Site
  • Eastpointe, MI
National Provider Identifier
1730754656
Registry record updated May 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
DEDICATED PHYSICIANS GROUP OF MICHIGAN PLLC
Practice address
21811 Kelly Rd
Eastpointe, MI 48021-2793
Phone
(586) 649-3388
NPI assigned
May 24, 2021
Organization subpart
Yes
Parent organization
DEDICATED PHYSICIANS GROUP OF MICHIGAN PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 24, 2021

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

Authorized official

Name
Mary Chen
Title
Executive Officer
Phone
(305) 628-6117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

21811 Kelly Rd
Eastpointe, MI 48021-2793

Mailing address

1395 NW 167TH St
Miami Gardens, FL 33169-5710
Phone (305) 628-6117

Other names 1

  • Dedicated Senior Medical Center Eastpointe Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2228672Dedicated Senior Medical Center - Eastpointe21811 Kelly Road, Eastpointe, MI 48021Certificate of waiverJun 28, 2027

National Provider Directory

National Provider Directory
Tax ID family
Dedicated Physicians Group of Michigan PLLC7 organizations share this tax ID, including this one
Part of
Dedicated Physicians Group of Michigan PLLC

Other organizations with this tax ID 6

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

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1621814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621814400000",
    "number": "1730754656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331695710",
            "telephone_number": "305-628-6117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21811 KELLY RD",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "480212793",
            "telephone_number": "586-649-3388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEDICATED PHYSICIANS GROUP OF MICHIGAN PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEDICATED PHYSICIANS GROUP OF MICHIGAN PLLC",
        "enumeration_date": "2021-05-24",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A",
        "authorized_official_last_name": "CHEN",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "305-628-6117"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dedicated Senior Medical Center Eastpointe",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eastpointe, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.