MMG 1PC (NPI# 1023037025) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023037025 |
| Entity Type | Organization |
| Organization Name | MMG 1PC |
| Practice Address |
28625 Northwestern Hwy Suite 213 Southfield MI 48034-1828 |
| Mailing Address |
29992 Northwestern Hwy Ste C Farmington Hills MI 48334-3292 |
| Practice Telephone | 2483549666 |
| Practice Fax Number | 2483543653 |
| Mailing Telephone | 2488511430 |
| Mailing Fax Number | 2488515182 |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2018-09-20 |
| Authorized Official Name | DR. GEOFFREY A TRIVAX (PRESIDENT) |
| Authorized Official Telephone | 3135383099 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BLUE SHIELD GROUP | 500F318990 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215040506 | Mmg 1pc | Internal Medicine | 28625 Northwestern Hwy Ste 100, Southfield, MI 48034-8351 | 2006-08-17 |
| 1285873430 | Mmg 1pc | Physical Medicine & Rehabilitation | 28625 Northwestern Hwy, Suite 150, Southfield, MI 48034-1828 | 2009-02-11 |
| 1184878001 | Mmg 1pc | Psychiatry & Neurology | 26400 W 12 Mile Rd, Suite 170, Southfield, MI 48034-1700 | 2008-11-05 |
| 1215103940 | Mmg 1pc | General Practice | 28625 Northwestern Hwy, Suite 213, Southfield, MI 48034-1828 | 2008-05-02 |
| 1972700607 | Mmg 1pc | Physical Therapist | 26400 W 12 Mile Rd, Suite 25, Southfield, MI 48034-1700 | 2007-06-27 |
| 1881714723 | Mmg 1pc | Internal Medicine | 28000 Joy Rd, Livonia, MI 48150-4137 | 2007-03-31 |
| 1629184049 | Mmg 1pc | Internal Medicine | 28625 Northwestern Hwy, Suite 223, Southfield, MI 48034-1828 | 2006-08-21 |
| 1679586192 | Mmg 1pc | Internal Medicine | 29201 Telegraph Rd, Suite 404, Southfield, MI 48034-1331 | 2006-08-14 |
| 1205855186 | Mmg 1pc | Internal Medicine | 7419 Middlebelt Rd, Suite 4, West Bloomfield, MI 48322-4182 | 2006-07-19 |
| 1073548442 | Mmg 1pc | Internal Medicine | 6900 Orchard Lake Rd, Suite 303, West Bloomfield, MI 48322-3405 | 2006-07-12 |
| Street Address |
28625 NORTHWESTERN HWY SUITE 213 |
| City | SOUTHFIELD |
| State | MI |
| Zip Code | 48034-1828 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477543874 | Sidney B Beck | Otolaryngology | 28625 Northwestern Hwy, Ste 1507, Southfield, MI 48034-1828 | 2005-10-26 |
| 1720369358 | Michigan Healthcare Professionals | Clinic/Center | 28625 Northwestern Hwy, Suite C, Southfield, MI 48034-1828 | 2011-09-09 |
| 1356661722 | Christy Stockton Parent | Physician Assistant | 28625 Northwestern Hwy, Southfield, MI 48034-1828 | 2010-06-08 |
| 1285873430 | Mmg 1pc | Physical Medicine & Rehabilitation | 28625 Northwestern Hwy, Suite 150, Southfield, MI 48034-1828 | 2009-02-11 |
| 1033367362 | Herman Kado | Internal Medicine | 28625 Northwestern Hwy, Suite 150, Southfield, MI 48034-1828 | 2008-08-28 |
| 1215103940 | Mmg 1pc | General Practice | 28625 Northwestern Hwy, Suite 213, Southfield, MI 48034-1828 | 2008-05-02 |
| 1255506556 | Mi Healthcare Professionals PC | Clinic/Center | 28625 Northwestern Hwy, Suite 100, Southfield, MI 48034-1828 | 2008-04-28 |
| 1972672103 | Arthur A Efros | Internal Medicine | 28625 Northwestern Hwy, Suite 213, Southfield, MI 48034-1828 | 2006-11-06 |
| 1629184049 | Mmg 1pc | Internal Medicine | 28625 Northwestern Hwy, Suite 223, Southfield, MI 48034-1828 | 2006-08-21 |
| 1174530398 | Nancy B. Berman | Nurse Practitioner | 28625 Northwestern Hwy, Suite 213, Southfield, MI 48034-1828 | 2006-08-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780219196 | I. R. Horn & Associates LLC | Community/Behavioral Health | 29623 Norhtwestern Hwy Suite 5, Southfield, MI 48034 | 2020-03-05 |
| 1003378753 | Alexis Shivers | Physical Therapy Assistant | 27500 Lahser Rd, Southfield, MI 48034 | 2019-04-02 |
| 1598257768 | El-abbadi Pediatric Clinic | Pediatrics | 24676 Lahser Road, Southfield, MI 48034 | 2018-06-04 |
| 1689166894 | Recore Rehabilitation Services | Clinic/Center | 25899 W 12 Mile Rd # 340, Southfield, MI 48034 | 2018-06-04 |
| 1578063749 | El-abbadi Healthcare Center | Clinic/Center | 27403 Lahser Rd, Southfield, MI 48034 | 2018-02-14 |
| 1063924819 | Diagnostic Hematology, PC | Clinical Medical Laboratory | 24725 W. Twelve Mile Road, Suite 118, Southfield, MI 48034 | 2017-11-02 |
| 1962929125 | Toms Holistic Home Visits Pllc | Clinic/Center | 28675 Franklin Rd, Suite 217, Southfield, MI 48034 | 2017-08-28 |
| 1265956940 | Abbadi Healthcare | Pharmacy | 27402 Lahser Road, Southfield, MI 48034 | 2017-08-03 |
| 1720517113 | Theramedic Home Health Care LLC | Home Health | 26400 W. 12 Mile Rd, Suite 80, Southfield, MI 48034 | 2017-06-08 |
| 1538695804 | Adrienne Rutherford | Occupational Therapist | 25999 Franklin Pointe Dr, Southfield, MI 48034 | 2017-05-05 |
| Find all providers in zip 48034 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851932446 | Adina Derecichei Parrish | Nurse Practitioner | 22255 Greenfield Rd Ste 422, Southfield, MI 48075-3730 | 2019-10-04 |
| 1447813092 | Violette Abellera Concepcion | Nurse Practitioner | 17515 W 9 Mile Rd Ste 200, Southfield, MI 48075-4404 | 2019-04-18 |
| 1083172878 | Jaafer Beydoun | Nurse Practitioner | 20180 W 12 Mile Rd Ste 200, Southfield, MI 48076-5412 | 2019-03-11 |
| 1902398787 | Fatoumata Moukir Ndukwe | Nurse Practitioner | 24450 Evergreen Road, 215, Southfield, MI 48075-2022 | 2018-06-06 |
| 1861984817 | Danielle Marguerite Macintosh | Nurse Practitioner | 25130 Southfield Rd Ste 120, Southfield, MI 48075-1900 | 2018-06-05 |
| 1609393313 | Kimiko Parks | Nurse Practitioner | 29866 Spring Hill Dr, Southfield, MI 48076-5735 | 2017-08-23 |
| 1497114904 | Madeline Jenkins Succar | Nurse Practitioner | 16310 W 12 Mile Rd, Southfield, MI 48076-2925 | 2016-02-12 |
| 1629457213 | Deanna Chew | Nurse Practitioner | 20905 Greenfield Rd Ste 406, Southfield, MI 48075-5348 | 2015-05-28 |
| 1831591551 | Zahera Husaini | Nurse Practitioner | 20905 Greenfield Rd Ste 502, Southfield, MI 48075-5351 | 2014-09-25 |
| 1902044308 | Gail Lee Johnson | Nurse Practitioner | 26957 Northwestern Hwy, Suite 400, Southfield, MI 48033-4700 | 2009-01-23 |
| Find all providers in SOUTHFIELD | ||||
| City | SOUTHFIELD |
| Zip Code | 48034 |
Please comment or provide details below to improve the information on MMG 1PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.