Mariam Abdul-Hussein Abbas
Individual provider Active NPI Gerontology Nurse Practitioner · Southgate, MI
NPI 1982352811 · NPPES record last updated Mar 10, 2022
Key facts
- NPI
- 1982352811
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gerontology Nurse Practitioner 363LG0600X
- License
- 4704286635 (MI)
- Practice address
- 14799 Dix Toledo Rd
Southgate, MI 48195-2507 - Phone
- (734) 324-8326
- NPI assigned
- Mar 10, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Vitality Health Clinic PLLC
Practice addresses (Care Compare)
4245 S Beech Daly St
Dearborn Heights, MI 48125-1576
Phone (313) 422-1270
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220518000648 | MI | Practitioner - Nurse Practitioner | 3577717347 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704286635 | MI | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Team Wellness Center | Current |
Accepting new patients | |
| Team Mental Health Services Inc. | Current |
Accepting new patients | |
| Vitality Health Clinic | Current | Accepting new patients | |
| Vitality Health Clinic PLLC | Current |
Accepting new patients |
Locations
290 Town Center Dr
Ste 400
Dearborn, MI 48126
Phone (248) 763-5289
921 Howard St
Dearborn, MI 48124
Phone (313) 274-3700
4245 S Beech Daly St
Ste 102
Dearborn Heights, MI 48125
Phone (313) 414-0703
4245 S Beech Daly St
Dearborn Hts, MI 48125
Phone (313) 422-1270
2925 Russell St
Detroit, MI 48207
Phone (313) 462-4714
14799 Dix Toledo Rd
Southgate, MI 48195
Phone (888) 813-8326
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 4704286635 | MI | Yes |
Addresses
Primary practice location
14799 Dix Toledo Rd
Southgate, MI 48195-2507
Mailing address
732 Dover St
Dearborn Heights, MI 48127-4114
Phone (313) 671-8961
Other providers in Southgate, MI
- -
- 20 20 Contacts - Eyeglasses Inc.
- A.M. Mussani, MD., P.C.
- Ali Hussein Abdallah
- Nasri Abdelnour
- Ali Abdul-Hadi
- Amal Mohamed Ali Abdul-Hussein
- Husam Abed
All providers in Southgate, MI · Gerontology Nurse Practitioner in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.