Active NPI
Van C. Momon, M.D.
- Pediatrics Physician
- Dearborn, MI
National Provider Identifier
1942357751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 4301047888
- Practice address
- Henry Ford Health System
5500 Auto Club Drive, Suite 160
Dearborn, MI 48126 - Phone
- (313) 425-4700
- NPI assigned
- Jan 4, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 4301047888 | MI | Primary |
Addresses
Primary practice location
Henry Ford Health System
5500 Auto Club Drive, Suite 160
Dearborn, MI 48126
Mailing address
Henry Ford Health System
5500 Auto Club Drive, Suite 160
Dearborn, MI 48126
Phone (313) 425-4700
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 175499010 | Medicaid | MI | |
| 700H262280 | Other | BLUE CROSS-BLUE CROSS | |
| VM047888 | Other | CHAMPUS-CHAMPUS | |
| VM047888 | Other | COMMERCIAL-COMMERCIAL NUMBER |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | vmomon12760@direct.hfhs.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301047888 | MI | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Henry Ford Health System | Pediatrics | Current | Accepting new patients |
| Henry Ford Health System | Current | Accepting new patients | |
| Henry Ford Health System | Current | Accepting new patients | |
| Henry Ford Maplegrove Center | Past | Accepting new patients |
Locations
5500 Auto Club Dr
Ste 160
Dearborn, MI 48126
Phone (313) 425-4700
1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953
2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Detroit, MI
- NPI 1134144801
-
- Pediatrics Physician
- Detroit, MI
- NPI 1003990318
-
- Community/Retail Pharmacy
- Plymouth, MI
- NPI 1942931720
-
- Children's Substance Abuse Rehabilitation Facility
- West Bloomfield, MI
- NPI 1295767630
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615420800000",
"number": "1942357751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "HENRY FORD HEALTH SYSTEM",
"address_2": "5500 AUTO CLUB DRIVE, SUITE 160",
"city": "DEARBORN",
"state": "MI",
"postal_code": "48126",
"telephone_number": "313-425-4700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "HENRY FORD HEALTH SYSTEM",
"address_2": "5500 AUTO CLUB DRIVE, SUITE 160",
"city": "DEARBORN",
"state": "MI",
"postal_code": "48126",
"telephone_number": "313-425-4700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOMON",
"first_name": "VAN",
"middle_name": "C.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-04",
"last_updated": "2021-03-11",
"certification_date": "2021-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "4301047888",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "175499010",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS-BLUE CROSS",
"identifier": "700H262280",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS-CHAMPUS",
"identifier": "VM047888",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMERCIAL-COMMERCIAL NUMBER",
"identifier": "VM047888",
"state": null
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "vmomon12760@direct.hfhs.org",
"affiliation": "N",
"address_1": "Henry Ford Health System",
"address_2": "5500 Auto Club Drive, Suite 160",
"city": "Dearborn",
"state": "MI",
"country_code": "US",
"postal_code": "48126",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.