NPIMap

Organization Active NPI

University Physician Group

Doing business as Wayne State University Physician Group

  • Occupational Therapist
  • Dearborn, MI
National Provider Identifier
1851630206
Registry record updated Oct 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
4301028224 Issued in MI
Legal business name
UNIVERSITY PHYSICIAN GROUP
Doing business as
Wayne State University Physician Group
Practice address
18100 Oakwood Blvd
Suite 300
Dearborn, MI 48124-4085
Phone
(313) 429-7977
Fax
(313) 429-7981
NPI assigned
Feb 5, 2013
Last updated
Oct 26, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2016

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

Authorized official

Name
Mr. Jeffery P Kohlitz
Title
Chief Financial Officer
Phone
(248) 581-5930

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 4301028224 MI Primary

Addresses

Primary practice location

18100 Oakwood Blvd
Suite 300
Dearborn, MI 48124-4085

Mailing address

1560 E. Maple Rd.
Suite 400-Credentialing
Troy, MI 48083-1138
Phone (248) 581-5973

Other identifiers 2

IdentifierTypeStateIssuer
0P30630OtherMIMEDICARE GROUP#
0H28367OtherMIBCBSM GROUP #

Other names 1

  • Wayne State University Physician Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060419000518 MI Part B Supplier - Clinic/Group Practice 8628087681 Receives reassigned benefits from 755 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Detroit, MI; Farmington Hills, MI; Flint, MI; Highland Park, MI; Livonia, MI; Roseville, MI; Southfield, MI; Southgate, MI…

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
University Physician Group13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

18100 Oakwood Blvd
Ste 300
Dearborn, MI 48124
Phone (313) 240-4900

400 Mack Ave
Ste 2
Detroit, MI 48201
Phone (313) 448-9006

4201 Saint Antoine St
Ste 8B
Detroit, MI 48201

Practitioners & affiliated clinicians

Practitioners 48

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 48

NPI Registry JSON

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

{
    "created_epoch": "1360022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477440000000",
    "number": "1851630206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 E. MAPLE RD.",
            "address_2": "SUITE 400-CREDENTIALING",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831138",
            "telephone_number": "248-581-5973",
            "fax_number": "248-581-5640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18100 OAKWOOD BLVD",
            "address_2": "SUITE 300",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481244085",
            "telephone_number": "313-429-7977",
            "fax_number": "313-429-7981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY PHYSICIAN GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-05",
        "last_updated": "2016-10-26",
        "status": "A",
        "authorized_official_last_name": "KOHLITZ",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "248-581-5930",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "4301028224",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP#",
            "identifier": "0P30630",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM GROUP #",
            "identifier": "0H28367",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wayne State University Physician Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dearborn, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2016; 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.