Individual provider Active NPI

M Bassem Hosein Dekelbab, MD

  • Pediatrics Physician
  • Royal Oak, MI
National Provider Identifier
1750376877
Registry record updated Jul 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4301059462 Issued in MI
Practice address
3535 W 13 Mile Rd Ste 707
Royal Oak, MI 48073-6770
Phone
(248) 551-0487
Fax
(248) 551-3696
NPI assigned
Sep 14, 2005
Last updated
Jul 15, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 4301059462 MI Primary

Addresses

Primary practice location

3535 W 13 Mile Rd Ste 707
Royal Oak, MI 48073-6770

Mailing address

26901 Beaumont Blvd Ste 3D
Southfield, MI 48033-3849
Phone (947) 522-1867

Other practice location 1

44199 Dequindre Rd Ste 615
Troy, MI 48085-1128
Phone (248) 964-9660

Other identifiers 1

IdentifierTypeStateIssuer
4749714MedicaidMI

Other names 1

  • M. Bassem Hosein Dekelbab Professional name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address MDEKELBAB19668@DIRECT.BEAUMONT.EDU

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
I20080326000491 MI Practitioner - Pediatric Medicine 1052497484 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

28100 Grand River Ave
Farmington Hills, MI 48336-5970

3535 W 13 Mile Rd
Royal Oak, MI 48073-6770

Merit-based Incentive Payment System (MIPS)

Final score
84.37 of 100Reported as group
Quality
66.73
Promoting interoperability
100
Improvement activities
40
Cost
70.98

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301059462MIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
William Beaumont Hospital Current Accepting new patients
Beaumont Medical Group- Specialty Services CurrentSince Mar 14, 2018 Accepting new patients
William Beaumont Hospital CurrentSince Jan 22, 2010 Accepting new patients
William Beaumont Hospital CurrentSince Jan 22, 2010 Accepting new patients
William Beaumont Hospital Past Accepting new patients

Locations

28100 Grand River Ave
Ste 301
Farmington Hills, MI 48336
Phone (947) 521-1320

3535 W 13 Mile Rd
#707
Royal Oak, MI 48073
Phone (248) 551-0487

3535 W 13 Mile Rd
Ste 707
Royal Oak, MI 48073
Phone (248) 551-0487

26001 Jefferson Ave
Saint Clair Shores, MI 48081
Phone (586) 779-7000

26901 Beaumont Blvd
Ste 3D
Southfield, MI 48033
Phone (947) 522-1860

130 Town Center Dr
Ste 203
Troy, MI 48084
Phone (248) 585-8250

44199 Dequindre Rd
Troy, MI 48085
Phone (248) 828-5083

44199 Dequindre Rd
Ste 615
Troy, MI 48085
Phone (248) 964-9660

Interoperability endpoints

  • Direct secure messaging: mdekelbab1124859@direct.hfhs.org
  • Direct secure messaging: mdekelbab1230913@epic00.shdirect.org
  • Direct secure messaging: mdekelbab19668@direct.beaumont.edu

Organizations & group practices 5

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": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657843200000",
    "number": "1750376877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849",
            "telephone_number": "947-522-1867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 W 13 MILE RD STE 707",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736770",
            "telephone_number": "248-551-0487",
            "fax_number": "248-551-3696"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "44199 Dequindre Rd Ste 615",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "MI",
            "postal_code": "480851128",
            "country_code": "US",
            "telephone_number": "248-964-9660",
            "fax_number": "248-964-9665",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEKELBAB",
        "first_name": "M BASSEM",
        "middle_name": "HOSEIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301059462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4749714",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "MDEKELBAB19668@DIRECT.BEAUMONT.EDU",
            "affiliation": "N",
            "address_1": "3535 W 13 Mile Rd Ste 707",
            "city": "Royal Oak",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480736770",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "M. BASSEM",
            "last_name": "DEKELBAB",
            "middle_name": "HOSEIN",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Royal Oak, MI

Sources for this page

Verify at the official NPI Registry.