Individual provider Active NPI

Van C. Momon, M.D.

  • Pediatrics Physician
  • Dearborn, MI
National Provider Identifier
1942357751
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4301047888 Issued in MI
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

Updated by the provider on Mar 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
175499010MedicaidMI
700H262280OtherBLUE CROSS-BLUE CROSS
VM047888OtherCHAMPUS-CHAMPUS
VM047888OtherCOMMERCIAL-COMMERCIAL NUMBER

Electronic endpoints 1

TypeEndpointUseAffiliation
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110204000391 MI Practitioner - Pediatric Medicine 4385824564 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301047888MIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health System Pediatrics CurrentSince Mar 1, 2010 Accepting new patients
Henry Ford Health System Current Accepting new patients
Henry Ford Health System CurrentSince Mar 1, 2010 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.

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

Verify at the official NPI Registry.