| Detroit Community Health Connection, Inc. | |
|
13901 E Jefferson Ave Detroit MI 48215-2720 | |
| (313) 822-0900 | |
| (313) 822-0950 |
| Full Name | Detroit Community Health Connection, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 13901 E Jefferson Ave, Detroit, Michigan |
| Authorized Official Name and Position | Mahipal Rao Kakarala (CFO) |
| Authorized Official Contact | 3138212591 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Detroit Community Health Connection, Inc. 13901 E Jefferson Ave Detroit MI 48215-2720 Ph: (313) 821-2591 | Detroit Community Health Connection, Inc. 13901 E Jefferson Ave Detroit MI 48215-2720 Ph: (313) 822-0900 |
| NPI Number | 1982611562 |
|---|---|
| Provider Enumeration Date | 08/03/2006 |
| Last Update Date | 06/24/2015 |
| Medicare PECOS PAC ID | 9234021148 |
|---|---|
| Medicare Enrollment ID | O20040326000067 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982611562 | NPI | - | NPPES |
| 1992196 | Medicaid | MI | |
| 1982611562 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Alan F Green |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275611667 PECOS PAC ID: 7416859418 Enrollment ID: I20040121000757 |
| Provider Name | Cynthia C Griggs |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1154421774 PECOS PAC ID: 0345209391 Enrollment ID: I20041215000023 |
| Provider Name | Linda M Green |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013947829 PECOS PAC ID: 2466404777 Enrollment ID: I20050215000718 |
| Provider Name | William L Jordan |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1497744932 PECOS PAC ID: 0840181491 Enrollment ID: I20050930000148 |
| Provider Name | Theodore K Graham |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1679562292 PECOS PAC ID: 9739108697 Enrollment ID: I20051121000438 |
| Provider Name | Ronaldo B Supena |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1275576886 PECOS PAC ID: 3476565680 Enrollment ID: I20060706000242 |
| Provider Name | Milagros P Reyes |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1386684843 PECOS PAC ID: 7911919162 Enrollment ID: I20060707000076 |
| Provider Name | George H Shade |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1437198314 PECOS PAC ID: 4880506955 Enrollment ID: I20060707000200 |
| Provider Name | Kimberly D Wallace |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1750327045 PECOS PAC ID: 9537168976 Enrollment ID: I20061212000221 |
| Provider Name | Lisa M Randon |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1316088644 PECOS PAC ID: 7810085792 Enrollment ID: I20071109000313 |
| Provider Name | Charlene V Williams |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1548462591 PECOS PAC ID: 1052495975 Enrollment ID: I20080229000508 |
| Provider Name | Christyne Lawson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063522506 PECOS PAC ID: 5991743379 Enrollment ID: I20080703000054 |
| Provider Name | Barbara J Mccloud |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679717268 PECOS PAC ID: 9739216342 Enrollment ID: I20100429000749 |
| Provider Name | Gouri Ramesh |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1982634119 PECOS PAC ID: 9335389964 Enrollment ID: I20130702000793 |
| Provider Name | Lavetta Pickens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295073773 PECOS PAC ID: 3779723614 Enrollment ID: I20130717000374 |
| Provider Name | Anita L Cain |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467588483 PECOS PAC ID: 9931342888 Enrollment ID: I20130826000545 |
| Provider Name | Jessica Simone Fladger |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1528455219 PECOS PAC ID: 3971823535 Enrollment ID: I20150521001128 |
| Provider Name | Charlene M Smith |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1750418083 PECOS PAC ID: 8729335724 Enrollment ID: I20180723001382 |
| Provider Name | Jessica Douglas-daniel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851884621 PECOS PAC ID: 3678820289 Enrollment ID: I20180726003257 |
| Provider Name | Caitlin Elizabeth Vanderwindt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487059069 PECOS PAC ID: 6406170075 Enrollment ID: I20190124002407 |
| Provider Name | Marna Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861975856 PECOS PAC ID: 9032456819 Enrollment ID: I20190201000682 |
| Provider Name | Tamika Rochelle Hawkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598327470 PECOS PAC ID: 9234467135 Enrollment ID: I20190829002006 |
| Provider Name | Sara Laith Sara |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962814160 PECOS PAC ID: 5890088496 Enrollment ID: I20191003002710 |
| Provider Name | Angela Jayne Wolf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144774472 PECOS PAC ID: 0143630129 Enrollment ID: I20201103000233 |
| Provider Name | Brenda Joyce Thomas |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1679508964 PECOS PAC ID: 8123919776 Enrollment ID: I20211015001732 |
| Provider Name | Nicole Lynne Audritsh |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1245750801 PECOS PAC ID: 5092103853 Enrollment ID: I20211027001632 |
| Provider Name | Kelli Cierra Wall |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1508511122 PECOS PAC ID: 5698153989 Enrollment ID: I20220526002637 |
| Provider Name | Ruby N Nzoma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609414218 PECOS PAC ID: 7517323736 Enrollment ID: I20230515000313 |
| Provider Name | Misty Head |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1194504035 PECOS PAC ID: 2062863772 Enrollment ID: I20240108000374 |
| Provider Name | Latasha Keller |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1023886751 PECOS PAC ID: 4183068901 Enrollment ID: I20240221000264 |
Central City Health (cherry Health) Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8333 Townsend St, Detroit, MI 48213 Phone: 313-831-3160 | |
Smith Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7800 W Outer Dr, Suite 230, Detroit, MI 48235 Phone: 313-535-0900 Fax: 313-535-3810 | |
St. John Hospital And Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 22101 Moross Rd, Detroit, MI 48236 Phone: 586-753-0011 | |
Chass Mack Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3426 Mack Avenue, Detroit, MI 48207 Phone: 313-849-3920 | |
Health Care Medical Center Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 17141 Hayes St, Detroit, MI 48205 Phone: 313-245-1700 Fax: 313-245-1701 | |
Mizrahi Medicine Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 7633 E Jefferson Ave Ste 250, Detroit, MI 48214 Phone: 313-821-3338 Fax: 313-823-5363 | |
T L Sea Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 15201 W Mcnichols Rd, Detroit, MI 48235 Phone: 313-516-3142 |