Detroit Wayne County Health Authority

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

DETROIT WAYNE COUNTY HEALTH AUTHORITY

Practice address

10809 Mack Ave
Detroit, MI 48214-2119

Phone

(313) 824-1000

Fax

(313) 824-9000

NPI assigned

Jan 29, 2010

Last updated

May 19, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Loretta Bush

Title

Ceo

Phone

(313) 871-3751

Specialties & licenses 8

Addresses

Medicare fee-for-service enrollment

Enrolled in MI2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962733089. Details of each certification follow.

• CCN C71051 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN C71051

Legal name

DETROIT WAYNE COUNTY HEALTH AUTHORITY

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Dec 1, 2025

Last certification

Dec 1, 2025

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Enrollment address

10809 Mack Ave
Detroit, MI 48214-2119

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Detroit Wayne County Health Authority

  • Federally Qualified Health Center (FQHC)
  • Southfield, MI
  • NPI 1063364776

  4385982271

  Same PAC ID
• Detroit Wayne County Health Authority

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
  • NPI 1245182963

  4385982271

  Same PAC ID
• Detroit Wayne County Health Authority

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
  • NPI 1508718248

  4385982271

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Detroit Wayne County Health Authority

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
  • NPI 1508718248

  O20251203001765

  Same enrollment

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19827/brand/1/csg/1/fhir/r4

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 63

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.

• Mohamed Mosad Almaisari, DO

  • General Practice Physician
  • Detroit, MI
  • NPI 1588248280
  Medicare reassignment Care Compare group NPD
• Robert Warmack III

  • Professional Counselor
  • Southfield, MI
  • NPI 1538546775
  Medicare reassignment Care Compare group NPD
• Tiwanna Jeaninne Williams, FNP-BC

  • Family Nurse Practitioner
  • Detroit, MI
  • NPI 1003519885
  Medicare reassignment Care Compare group NPD
• Hassan Ali Saghir, M.D.

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1730390832
  Medicare reassignment Care Compare group
• Kehinde A. Ayeni, MD

  • Psychiatry Physician
  • Detroit, MI
  • NPI 1366520470
  Medicare reassignment NPD
• Quanta Dawn Duncan, RDN

  • Registered Dietitian
  • Detroit, MI
  • NPI 1114544426
  Medicare reassignment NPD
• Christina Ezell Kirkwood, APRN, FNP-BC

  • Family Nurse Practitioner
  • Southfield, MI
  • NPI 1497476006
  Medicare reassignment
• Ayesha M Taj, D.O.

  • Pediatric Adolescent Medicine Physician
  • Canton, MI
  • NPI 1801858733
  Medicare reassignment
• Michele Adams-Calloway, CHW

  • Community Health Worker
  • Detroit, MI
  • NPI 1881458248
  NPD
• Ryan Abboud, DO

  • Family Medicine Physician
  • Bingham Farms, MI
  • NPI 1104353077
  NPD (past)
• Farhad Ali Amiri, DO

  • Psychiatry Physician
  • Southfield, MI
  • NPI 1154703361
  NPD (past)
• Mark Frederick Balino, D.O.

  • Psychiatry Physician
  • Jackson, MI
  • NPI 1790105005
  NPD (past)

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

{
    "created_epoch": "1264723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779148800000",
    "number": "1962733089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3031 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023046",
            "telephone_number": "313-824-1000",
            "fax_number": "313-824-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10809 MACK AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482142119",
            "telephone_number": "313-824-1000",
            "fax_number": "313-824-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27777 Lahser Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Southfield",
            "state": "MI",
            "postal_code": "480344751",
            "country_code": "US",
            "telephone_number": "313-824-1000",
            "fax_number": "248-945-3498",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "23077 Greenfield Rd",
            "address_purpose": "LOCATION",
            "city": "Southfield",
            "state": "MI",
            "postal_code": "480753709",
            "country_code": "US",
            "telephone_number": "313-824-1000",
            "fax_number": "248-569-9151",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12121 Broadstreet Ave",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482041550",
            "country_code": "US",
            "telephone_number": "313-824-1000",
            "fax_number": "313-931-8656",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DETROIT WAYNE COUNTY HEALTH AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-29",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A",
        "authorized_official_last_name": "BUSH",
        "authorized_official_first_name": "LORETTA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "313-871-3751",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": "251K00000X",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Detroit Vamc
• Detroit Wayne County Community Mental Health Agency
• Detroit Wayne County Community Mental Health Agency
• Detroit Wayne County Health Authority
• Detroit Wayne County Health Authority
• Detroit Wayne Integrated Health Network
• Detroit Wayne Mental Health Authority
• Detroit Wayne Mental Health Authority
• Detroit Wayne Mental Health Authority
• Detroit-Macomb Hospital Corporation (St. John Riverview Hospital)

• Primary Care Clinic/Center in Detroit, MI
• Providers in Detroit, MI by specialty
• Primary Care Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.