Primary Care Clinic of Jackson, P.C.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

TA065207 Issued in MI

Legal business name

PRIMARY CARE CLINIC OF JACKSON, P.C.

Practice address

2218 Sugarloaf Ave
Portage, MI 49024-6771

Phone

(269) 327-9700

Fax

(269) 327-9701

NPI assigned

Nov 5, 2007

Last updated

Jul 20, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Tahir A Alvi, M.D.NPI 1174509855

Title

President

Phone

(269) 327-9700

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

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.

• Tahir Alvi, M.D.

  • Internal Medicine Physician
  • Kalamazoo, MI
  • NPI 1174509855
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1194220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248048000000",
    "number": "1821278193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1599",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492041599",
            "telephone_number": "269-327-9700",
            "fax_number": "269-327-9701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2218 SUGARLOAF AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490246771",
            "telephone_number": "269-327-9700",
            "fax_number": "269-327-9701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE CLINIC OF JACKSON, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-05",
        "last_updated": "2009-07-20",
        "status": "A",
        "authorized_official_last_name": "ALVI",
        "authorized_official_first_name": "TAHIR",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "269-327-9700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "TA065207",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3397804",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Portage, MI
• Providers in Portage, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2009; 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.