NPIMap

Organization Active NPI

Corazon Medical PC

  • Diagnostic Radiology Physician
  • Dearborn, MI
National Provider Identifier
1902511157
Registry record updated Feb 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
CORAZON MEDICAL PC
Practice address
1213 Mason St
Dearborn, MI 48124-2841
Phone
(888) 855-6020
NPI assigned
Jan 20, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2024

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

Authorized official

Name
Abir Mehanna
Title
Administrator
Phone
(888) 855-6020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

1213 Mason St
Dearborn, MI 48124-2841

Mailing address

1213 Mason St
Dearborn, MI 48124-2841

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230323001732 MI Part B Supplier - Clinic/Group Practice 1456725910 Receives reassigned benefits from 6 practitioners
Practice locations: Waterford, MI; Trenton, MI; Sterling Heights, MI; Saint Clair Shores, MI; Novi, MI; Mount Pleasant, MI; Madison Heights, MI; Macomb, MI…

National Provider Directory

National Provider Directory

Locations

2500 Midland Rd
Bay City, MI 48706

3949 Sparks Dr SE
Ste 101
Grand Rapids, MI 49546

211 S Crapo St
Ste F
Mt Pleasant, MI 48858
Phone (989) 773-2081

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1674172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709164800000",
    "number": "1902511157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1213 MASON ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1213 MASON ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242841",
            "telephone_number": "888-855-6020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORAZON MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-20",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A",
        "authorized_official_last_name": "MEHANNA",
        "authorized_official_first_name": "ABIR",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "888-855-6020"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Feb 29, 2024; 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.