NPIMap

Organization Active NPI

Forum Medical Clinic, PC

  • Internal Medicine Physician
  • Sterling Heights, MI
National Provider Identifier
1992734578
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
NM 069838 Issued in MI
Legal business name
FORUM MEDICAL CLINIC, PC
Practice address
43184 Dequindre Rd Ste 202
Sterling Heights, MI 48314-1709
Phone
(586) 580-0280
Fax
(586) 580-0281
NPI assigned
Jul 3, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Dr. Nicolas A Marsheh IV, M.D.NPI 1962423657
Title
Owner/Operator
Phone
(586) 580-0280

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NM 069838 MI Primary

Addresses

Primary practice location

43184 Dequindre Rd Ste 202
Sterling Heights, MI 48314-1709

Mailing address

43184 Dequindre Rd Ste 202
Sterling Heights, MI 48314-1709
Phone (586) 580-0280

Other identifiers 3

IdentifierTypeStateIssuer
0E00984OtherMIBCBS
1106348002OtherMIBCBSM
4732824MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051109000558 MI Part B Supplier - Clinic/Group Practice 5991723876 Receives reassigned benefits from 8 practitioners
Practice locations: Sterling Heights, MI; Warren, MI

National Provider Directory

National Provider Directory
Tax ID family
Forum Medical Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

555 Barclay Cir
Ste 200
Rochester Hills, MI 48307
Phone (248) 852-4145

13251 E 10 Mile Rd
Ste 100
Warren, MI 48089
Phone (586) 758-7880

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1992734578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43184 DEQUINDRE RD STE 202",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483141709",
            "telephone_number": "586-580-0280",
            "fax_number": "586-580-0281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43184 DEQUINDRE RD STE 202",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483141709",
            "telephone_number": "586-580-0280",
            "fax_number": "586-580-0281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORUM MEDICAL CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2023-03-07",
        "certification_date": "2020-10-19",
        "status": "A",
        "authorized_official_last_name": "MARSHEH",
        "authorized_official_first_name": "NICOLAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "586-580-0280",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "IV",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "NM 069838",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0E00984",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "1106348002",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4732824",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sterling Heights, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.