Individual provider Active NPI

Keith E. Mullins, MD

  • Gastroenterology Physician
  • Dearborn, MI
National Provider Identifier
1992090906
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
4301098887 Issued in MI
Practice address
19401 Hubbard Dr
Dearborn, MI 48126-2641
Phone
(313) 982-8307
Fax
(313) 982-8320
NPI assigned
Jun 17, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 4301098887 MI Primary

Addresses

Primary practice location

19401 Hubbard Dr
Dearborn, MI 48126-2641

Mailing address

2799 W Grand Blvd
Gastroenterology, K-7
Detroit, MI 48202-2608
Phone (313) 916-2405

Other practice location 1

2799 W Grand Blvd
Gastroenterology, K-7
Detroit, MI 48202-2608
Phone (313) 916-2405

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
I20170627001374 MI Practitioner - GastroenterologyPractitioner - Internal Medicine 3678894359 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Wayne State University School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 916-2600

Hospital & facility affiliations

  • Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053
  • Henry Ford Health West Bloomfield Hospital Hospital, W Bloomfield, MI, CCN 230302

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy125
Upper gastrointestinal (GI) endoscopy for acid reflux92

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health System Gastroenterology CurrentSince Jun 1, 2017 Accepting new patients
Henry Ford Pathology Current Accepting new patients
Henry Ford Health System Current Accepting new patients
Henry Ford Health System CurrentSince Jun 1, 2017 Accepting new patients
Henry Ford Maplegrove Center Past Accepting new patients

Locations

19401 Hubbard Dr
Dearborn, MI 48126
Phone (313) 982-8100

2799 W Grand Blvd
#K7
Detroit, MI 48202
Phone (313) 916-2405

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

2799 W Grand Blvd
#363
Detroit, MI 48202
Phone (313) 916-2020

2799 W Grand Blvd
#K7A6
Detroit, MI 48202

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

24555 Haig St
Taylor, MI 48180
Phone (313) 292-6260

6777 W Maple Rd
West Bloomfield, MI 48322
Phone (248) 325-1000

Interoperability endpoints

  • Direct secure messaging: kmullins282190@direct.hfhs.org

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1308268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1992090906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2799 W GRAND BLVD",
            "address_2": "GASTROENTEROLOGY, K-7",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022608",
            "telephone_number": "313-916-2405",
            "fax_number": "313-916-6413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19401 HUBBARD DR",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262641",
            "telephone_number": "313-982-8307",
            "fax_number": "313-982-8320"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2799 W Grand Blvd",
            "address_2": "Gastroenterology, K-7",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482022608",
            "country_code": "US",
            "telephone_number": "313-916-2405",
            "fax_number": "313-916-6413",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MULLINS",
        "first_name": "KEITH",
        "middle_name": "E.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-17",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MI",
            "license": "4301098887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.