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GREAT LAKES MEDICAL GROUP PC
NPI 1053787853
Internal Medicine in Eastpointe, MI

Active since August 15, 2015
19070 E 10 MILE RD, EASTPOINTE, MI 48021(313) 418-9952 Get Directions Write a Review

NPPES record last updated: August 15, 2015. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Great Lakes Medical Group Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GREAT LAKES MEDICAL GROUP PC (NPI 1053787853) is a healthcare organization registered as an internal medicine in Eastpointe, Michigan and active in the NPI registry since August 2015. The organization lists Mohamad Rahbar, President, as its authorized official.

NPPES Registry Identity

NPI1053787853
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameGREAT LAKES MEDICAL GROUP PC
Location Address19070 E 10 MILE RDEastpointe, MI 48021-1449
Mailing Address19070 E 10 Mile RdEastpointe, MI 48021-1449 · (313) 418-9952
Phone(313) 418-9952
Organization SubpartNo
Authorized OfficialMohamad RahbarPresident · (313) 418-9952
Enumeration DateAugust 15, 2015
✔ NPI 1053787853 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in MI · 5315012655
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
19070 E 10 MILE RD, Eastpointe, MI 48021
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Great Lakes Medical Group Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

9

Medicare enrollment records show 9 clinicians reassign Medicare billing to Great Lakes Medical Group PC, which bills Medicare for the services they deliver. They are listed nearest first.

Clinicians, nearest first (9)

Stacy Conn, NP
Nurse Practitioner
NPI 1780226613
71320 WEEKS RD
Richmond, MI 48062
(586) 405-1290
✔ PECOS✔ Accepts Medicare10 mi
Omar Saaed, MD
Internal Medicine
NPI 1700406154
42850 SCHOENHERR RD STE 3
Sterling Heights, MI 48313
(872) 985-1059
✔ PECOS✔ Accepts Medicare14 mi
Katarzyna Brock, NP
Nurse Practitioner
NPI 1235701798
19070 E 10 MILE RD
Eastpointe, MI 48021
(586) 445-0177
✔ PECOS17 mi
April Provenzino, NP-C
Nurse Practitioner
NPI 1386194066
19070 E 10 MILE RD
Eastpointe, MI 48021
(586) 445-0177
✔ PECOS✔ Accepts Medicare17 mi
Mohamad Rahbar, M.D.
Internal Medicine
NPI 1679567762
18263 E 10 MILE RD SUITE D
Roseville, MI 48066
(586) 778-4950
✔ PECOS✔ Accepts Medicare17 mi
Suham Salman, N.P.
Nurse Practitioner
NPI 1326360504
18263 E 10 MILE RD SUITE D
Roseville, MI 48066
(586) 778-4950
✔ PECOS17 mi
Tesfamariam Metiku, M.D.
Internal Medicine
NPI 1427289339
21409 KELLY RD STE 400
Eastpointe, MI 48021
(586) 777-0630
✔ PECOS18 mi
Humaira Rizvi, MD
Internal Medicine
NPI 1225447766
22101 MOROSS RD PROFESSIONAL BULIDING 2 SUITE 50
Detroit, MI 48236
(313) 343-7784
✔ PECOS✔ Accepts Medicare20 mi
Hiro Rahbar, MD
Family Practice
NPI 1093151540
400 COLONNADE DR
Ponte Vedra, FL 32081
(904) 824-1020
✔ PECOS870 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Great Lakes Medical Group PC's NPI number?

The NPI number for Great Lakes Medical Group PC is 1053787853. It was assigned to this organization in the NPPES registry on August 15, 2015.

Where is Great Lakes Medical Group PC located?

Great Lakes Medical Group PC is located at 19070 E 10 Mile Rd, Eastpointe, MI 48021. The listed phone number is (313) 418-9952.

What is Great Lakes Medical Group PC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Great Lakes Medical Group PC enrolled in Medicare?

Yes. Great Lakes Medical Group PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Great Lakes Medical Group PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 9 clinicians in 3 Medicare specialties reassign their Medicare billing to Great Lakes Medical Group PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Internal Medicine (4), Nurse Practitioner (4) and Family Practice (1). Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Great Lakes Medical Group PC accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Great Lakes Medical Group PC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Great Lakes Medical Group PC was last updated on August 15, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.