Active NPI
Kassem Soufan, MD
- Family Medicine Physician
- Canton, MI
National Provider Identifier
1972170652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4301511386
- Practice address
- 2050 N Haggerty Rd
Canton, MI 48187-3795 - Phone
- (734) 446-9757
- NPI assigned
- Jun 9, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301511386 | MI | Primary |
Addresses
Primary practice location
2050 N Haggerty Rd
Canton, MI 48187-3795
Mailing address
26901 Beaumont Blvd Ste 3D
Southfield, MI 48033-3849
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ksoufan967470@direct.beaumont.edu | Direct |
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
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240822002710 | MI | Practitioner - Family Practice | 3678973591 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Wayne State University School of Medicine, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Oakwood Ambulatory LLC
Practice addresses (Care Compare)
2050 N Haggerty Rd
220 Corewell Health Family Medicine
Canton, MI 48187-3796
Phone (734) 446-9757
Hospital & facility affiliations
- Beaumont Hospital Royal Oak
- Corewell Health Wayne Hospital
- Beaumont Hospital - Dearborn
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301511386 | MI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oakwood Ambulatory LLC | Family Medicine | Current | Accepting new patients |
| Oakwood Ambulatory, LLC | Current | Accepting new patients |
Locations
201 3rd St
Ste 200
Belleville, MI 48111
Phone (734) 697-9065
2050 N Haggerty Rd
Ste 220
Canton, MI 48187
Phone (734) 446-9757
26901 Beaumont Blvd
Ste 3D
Southfield, MI 48033
Phone (947) 522-1860
33155 Annapolis St
Wayne, MI 48184
Phone (734) 467-4042
Interoperability endpoints
- ksoufan1256965@epic00.shdirect.org
- ksoufan967470@direct.beaumont.edu
Organizations & group practices 2
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.
-
- Podiatrist
- Westland, MI
- NPI 1013157361
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623196800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730246400000",
"number": "1972170652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26901 BEAUMONT BLVD STE 3D",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480333849"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2050 N HAGGERTY RD",
"city": "CANTON",
"state": "MI",
"postal_code": "481873795",
"telephone_number": "734-446-9757"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUFAN",
"first_name": "KASSEM",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-06-09",
"last_updated": "2024-10-30",
"certification_date": "2024-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4301511386",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "ksoufan967470@direct.beaumont.edu",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "2050 N Haggerty Rd",
"city": "Canton",
"state": "MI",
"country_code": "US",
"postal_code": "481873795",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Canton, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.