NPIMap

Organization Active NPI

Wholistic Center for Restorative Health PLLC

  • Primary Care Clinic/Center
  • Southfield, MI
National Provider Identifier
1770207680
Registry record updated Oct 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
WHOLISTIC CENTER FOR RESTORATIVE HEALTH PLLC
Practice address
20905 Greenfield Rd Ste 600
Southfield, MI 48075-5355
Phone
(586) 879-1921
NPI assigned
Oct 4, 2022
Last updated
Oct 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2022

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

Authorized official

Name
Camille Johnson, MDNPI 1558337147
Title
Owner
Phone
(313) 858-8480

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
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

20905 Greenfield Rd Ste 600
Southfield, MI 48075-5355

Mailing address

19785 W 12 Mile Rd # 591
Southfield, MI 48076-2584
Phone (313) 858-8480

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221101000480 MI Part B Supplier - Clinic/Group Practice 2466829668 Receives reassigned benefits from 1 practitioner
Practice locations: Southfield, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1664841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664841600000",
    "number": "1770207680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19785 W 12 MILE RD # 591",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762584",
            "telephone_number": "313-858-8480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20905 GREENFIELD RD STE 600",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480755355",
            "telephone_number": "586-879-1921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHOLISTIC CENTER FOR RESTORATIVE HEALTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-04",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CAMILLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-858-8480",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2022; 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.