NPIMap

Organization Active NPI

Geriatric Associates of Michigan, PLLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Warren, MI
National Provider Identifier
1881172989
Registry record updated Apr 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
GERIATRIC ASSOCIATES OF MICHIGAN, PLLC
Practice address
28655 Hoover Rd
Warren, MI 48093-4105
Phone
(586) 393-1330
Fax
(586) 393-1308
NPI assigned
Jul 31, 2018
Last updated
Apr 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2023

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

Authorized official

Name
Bruce Johnson, DONPI 1245236215
Title
Owner
Phone
(586) 524-0897

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
Geriatric Medicine (Internal Medicine) Physician 207RG0300X NU Primary

Addresses

Primary practice location

28655 Hoover Rd
Warren, MI 48093-4105

Mailing address

28655 Hoover Rd
Warren, MI 48093-4105
Phone (586) 393-1330

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181001001205 MI Part B Supplier - Clinic/Group Practice 9436400447 Receives reassigned benefits from 13 practitioners
Practice locations: Southfield, MI; Warren, MI; Sterling Heights, MI; Saline, MI; Saint Clair Shores, MI; Madison Heights, MI; Harper Woods, MI; Grosse Pointe Woods, MI…

National Provider Directory

National Provider Directory

Locations

137 Keveling Dr
Saline, MI 48176
Phone (586) 393-1330

28655 Hoover Rd
Warren, MI 48093
Phone (586) 393-1330

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1532995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681257600000",
    "number": "1881172989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28655 HOOVER RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480934105",
            "telephone_number": "586-393-1330",
            "fax_number": "586-393-1308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28655 HOOVER RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480934105",
            "telephone_number": "586-393-1330",
            "fax_number": "586-393-1308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERIATRIC ASSOCIATES OF MICHIGAN, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-31",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "586-524-0897",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2023; 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.