Active NPI
Charles Wesley Baker, M.D.
- Internal Medicine Physician
- Detroit, MI
National Provider Identifier
1740364496
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 430 103 9100
- Practice address
- 2888 W Grand Blvd
Detroit, MI 48202-2612 - Phone
- (313) 875-5738
- Fax
- (313) 664-0811
- NPI assigned
- Oct 25, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 430 103 9100 | MI | Primary |
Addresses
Primary practice location
2888 W Grand Blvd
Detroit, MI 48202-2612
Mailing address
7700 2ND Ave
Detroit, MI 48202-2411
Phone (313) 875-5738
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2768354 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 430 103 9100 | MI | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Wellness Plan Medical Centers | Past | Accepting new patients | |
| Professional Medical Center PC | Internal Medicine | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/GCBDCD
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1740364496",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7700 2ND AVE",
"city": "DETROIT",
"state": "MI",
"postal_code": "482022411",
"telephone_number": "313-875-5738",
"fax_number": "313-875-5728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2888 W GRAND BLVD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482022612",
"telephone_number": "313-875-5738",
"fax_number": "313-664-0811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAKER",
"first_name": "CHARLES",
"middle_name": "WESLEY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "430 103 9100",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2768354",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.