NPIMap

Organization Active NPI

Pioneer Medical Group PLLC

  • Internal Medicine Physician
  • Detroit, MI
National Provider Identifier
1801304688
Registry record updated May 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PIONEER MEDICAL GROUP PLLC
Practice address
6071 W Outer Dr
Detroit, MI 48235-2624
Phone
(248) 912-8080
Fax
(734) 462-0340
NPI assigned
Jan 16, 2018
Last updated
May 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2020

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

Authorized official

Name
Rizwan Khan, MDNPI 1376876102
Title
Authorized Official
Phone
(248) 912-8080

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
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

6071 W Outer Dr
Detroit, MI 48235-2624

Mailing address

17177 N Laurel Park Dr Ste 439
Livonia, MI 48152-3938
Phone (734) 462-0340

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180131003349 MI Part B Supplier - Clinic/Group Practice 5092075598 Receives reassigned benefits from 41 practitioners
Practice locations: Detroit, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 41

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.

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1516060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590624000000",
    "number": "1801304688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17177 N LAUREL PARK DR STE 439",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481523938",
            "telephone_number": "734-462-0340",
            "fax_number": "734-462-0344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6071 W OUTER DR",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482352624",
            "telephone_number": "248-912-8080",
            "fax_number": "734-462-0340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIONEER MEDICAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-16",
        "last_updated": "2020-05-28",
        "certification_date": "2020-05-28",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "RIZWAN",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "248-912-8080",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "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 May 28, 2020; 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.