Individual provider Active NPI

Sumaiya Islam

  • Family Medicine Physician
  • Detroit, MI
National Provider Identifier
1790168557
Registry record updated Jun 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301108155 Issued in MI
Practice address
3370 E Jefferson Ave
Detroit, MI 48207-4236
Phone
(313) 656-1600
NPI assigned
Jun 29, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 29, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301108155 MI Primary

Addresses

Primary practice location

3370 E Jefferson Ave
Detroit, MI 48207-4236

Mailing address

1350 W Bethune St
1205
Detroit, MI 48202-2600
Phone (313) 335-6195

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
I20180716001499 MI Practitioner - Family Practice 4688987290 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

22505 Allen Rd
Woodhaven, MI 48183-2237
Phone (734) 671-6217

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health System CurrentSince Jun 9, 2018 Accepting new patients
Henr Y Ford Health System Family Medicine CurrentSince Jun 9, 2018 Accepting new patients
Henry Ford Health System Current Accepting new patients

Locations

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

3370 E Jefferson Ave
Detroit, MI 48207
Phone (313) 656-1600

22505 Allen Rd
Woodhaven, MI 48183
Phone (734) 671-6217

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1435536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435536000000",
    "number": "1790168557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 W BETHUNE ST",
            "address_2": "1205",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022600",
            "telephone_number": "313-335-6195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3370 E JEFFERSON AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482074236",
            "telephone_number": "313-656-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISLAM",
        "first_name": "SUMAIYA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-29",
        "last_updated": "2015-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301108155",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.