DETROIT WAYNE COUNTY HEALTH AUTHORITY – Federally Qualified Health Center (FQHC), NPI 1962733089
Federally Qualified Health Center (FQHC)
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for DETROIT WAYNE COUNTY HEALTH AUTHORITY
3031 W GRAND BLVD STE 600
DETROIT, MI 482023014
Phone: (313) 871-3751
Fax: (313) 871-3756
Type: Location
27777 Lahser Rd Ste 200
Southfield, MI 480344751
Phone: (313) 824-1000
Fax: (248) 945-3498
Type: Location
23077 Greenfield Rd
Southfield, MI 480753709
Phone: (313) 824-1000
Fax: (248) 569-9151
Type: Location
12121 Broadstreet Ave
Detroit, MI 482041550
Phone: (313) 824-1000
Fax: (313) 931-8656
Type: Location
10809 MACK AVE
DETROIT, MI 482142119
Phone: (313) 824-1000
Fax: (313) 824-9000
Type: Location
New Center One, 3031, West Grand Boulevard, New Center, Detroit, Wayne County, Michigan, 48202, United States
DETROIT, MI 482023046
Phone: (313) 824-1000
Fax: (313) 824-9000
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-12-03
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-06-30 (712 days ago).
Enrollment records
2
Earliest due date
2024-06-30
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20190219003271 | O | Clinic/Group Practice | MI | 2024-06-30 |
| O20251203001765 | O | Federally Qualified Health Center (Fqhc) | MI | TBD |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 48202)
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