NPIMap

Organization Active NPI

Prime Care Medical Clinic PLLC

  • Internal Medicine Physician
  • Dearborn, MI
National Provider Identifier
1861702433
Registry record updated Dec 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301085126 Issued in MI
Legal business name
PRIME CARE MEDICAL CLINIC PLLC
Practice address
13840 W Warren Ave
Dearborn, MI 48126-1425
Phone
(313) 581-8080
Fax
(313) 581-8383
NPI assigned
Oct 18, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2011

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

Authorized official

Name
Fouad A Dakhlallah, M.D.NPI 1679592877
Title
Owner
Phone
(313) 581-8080

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: 193400000X SINGLE SPECIALTY GROUP 207R00000X 4301085126 MI Primary

Addresses

Primary practice location

13840 W Warren Ave
Dearborn, MI 48126-1425

Mailing address

13840 W Warren Ave
Dearborn, MI 48126-1425
Phone (313) 581-8080

Other identifiers 1

IdentifierTypeStateIssuer
4753252MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110121000398 MI Part B Supplier - Clinic/Group Practice 1052590171 Receives reassigned benefits from 9 practitioners
Practice locations: Dearborn, MI; Dearborn Heights, MI

National Provider Directory

National Provider Directory

Locations

13840 W Warren Ave
Dearborn, MI 48126
Phone (313) 581-7287

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BAIAAA

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1287360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322697600000",
    "number": "1861702433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13840 W WARREN AVE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481261425",
            "telephone_number": "313-581-8080",
            "fax_number": "313-581-8383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13840 W WARREN AVE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481261425",
            "telephone_number": "313-581-8080",
            "fax_number": "313-581-8383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME CARE MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-18",
        "last_updated": "2011-12-01",
        "status": "A",
        "authorized_official_last_name": "DAKHLALLAH",
        "authorized_official_first_name": "FOUAD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-581-8080",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301085126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4753252",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Dec 1, 2011; 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.