NPIMap

Organization Active NPI

Wayne Pediatrics Inc.

  • Pediatrics Physician
  • Detroit, MI
National Provider Identifier
1760015622
Registry record updated Feb 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
WAYNE PEDIATRICS INC.
Practice address
400 Mack Ave
Detroit, MI 48201-2136
Phone
(313) 577-5437
NPI assigned
Feb 19, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2020

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

Authorized official

Name
Dr. Herman Gray, MD
Title
President
Phone
(313) 577-3231

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

400 Mack Ave
Detroit, MI 48201-2136

Mailing address

656 Kirby, 4249 F.a.B.
Detroit, MI 48202

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210420000200 MI Part B Supplier - Clinic/Group Practice 4486062122 Receives reassigned benefits from 9 practitioners
Practice locations: Detroit, MI

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
23D2195089Wayne Pediatrics, Inc400 Mack Avenue Suite 1 East, Detroit, MI 48201Provider-performed microscopyOct 5, 2026

National Provider Directory

National Provider Directory

Locations

400 Mack Ave
Ste 9
Detroit, MI 48201

656 W Kirby St
#4249
Detroit, MI 48202

400 Mack Ave
Ste 1
Detroit, MI 48201
Phone (313) 448-9600

Practitioners & affiliated clinicians

Practitioners 12

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": "1582070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1760015622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "656 KIRBY, 4249 F.A.B.",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MACK AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012136",
            "telephone_number": "313-577-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE PEDIATRICS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-19",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "HERMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-577-3231",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Feb 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.