Active NPI
Dennis C Packey, DO
- Geriatric Medicine (Internal Medicine) Physician
- Grosse Pointe Woods, MI
National Provider Identifier
1821089236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician
- License
- 5101006508
- Practice address
- 20867 Mack Ave
Suite 3
Grosse Pointe Woods, MI 48236-1392 - Phone
- (313) 886-0600
- Fax
- (313) 886-0612
- NPI assigned
- Nov 3, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 5101006508 | MI | Primary |
Addresses
Primary practice location
20867 Mack Ave
Suite 3
Grosse Pointe Woods, MI 48236-1392
Mailing address
20867 Mack Ave
Suite 3
Grosse Pointe Woods, MI 48236-1392
Phone (313) 886-0600
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5101006508 | Other | CONTROLLED SUBSTANCE | |
| 4836838 | Medicaid | MI | |
| 4836829 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101006508 | MI | MD | Geriatric Medicine (Internal Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Henry Ford Health St. John Hospital | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- Detroit, MI
- NPI 1912965088
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1821089236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20867 MACK AVE",
"address_2": "SUITE 3",
"city": "GROSSE POINTE WOODS",
"state": "MI",
"postal_code": "482361392",
"telephone_number": "313-886-0600",
"fax_number": "313-886-0612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20867 MACK AVE",
"address_2": "SUITE 3",
"city": "GROSSE POINTE WOODS",
"state": "MI",
"postal_code": "482361392",
"telephone_number": "313-886-0600",
"fax_number": "313-886-0612"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACKEY",
"first_name": "DENNIS",
"middle_name": "C",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-03",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Geriatric Medicine",
"state": "MI",
"license": "5101006508",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONTROLLED SUBSTANCE",
"identifier": "5101006508",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4836838",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4836829",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grosse Pointe Woods, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.