EASTBORN CLINIC PLLC
NPI 1578801080
Internal Medicine in Dearborn, MI
About Eastborn Clinic Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
EASTBORN CLINIC PLLC (NPI 1578801080) is a healthcare organization registered as an internal medicine in Dearborn, Michigan and active in the NPI registry since January 2013. The organization holds a CLIA Waiver certificate valid through July 17, 2027 and lists Amin S Huballah, Physician Assistant, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Accepted 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)
Eastborn Clinic Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Eastborn Clinic PLLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 23D2062556
Eastborn Clinic · Dearborn, MIFrequently 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 Eastborn Clinic PLLC's NPI number?
The NPI number for Eastborn Clinic PLLC is 1578801080. It was assigned to this organization in the NPPES registry on January 18, 2013.
Where is Eastborn Clinic PLLC located?
Eastborn Clinic PLLC is located at 7526 Wyoming St Ste# 2, Dearborn, MI 48126. The listed phone number is (313) 834-4444.
What is Eastborn Clinic PLLC's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is Eastborn Clinic PLLC enrolled in Medicare?
Yes. Eastborn Clinic PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Eastborn Clinic PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Cardiovascular Disease (Cardiology)) reassigns their Medicare billing to Eastborn Clinic PLLC. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Eastborn Clinic PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 23D2062556) is associated with this NPI, valid through July 17, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Eastborn Clinic PLLC 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 Eastborn Clinic PLLC 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 Eastborn Clinic PLLC was last updated on April 30, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.
# Eastborn Clinic Pllc · NPI 1578801080
Internal Medicine organization in Dearborn, Michigan. Organization record, active in the CMS NPPES registry since January 18, 2013.
## Identity
- **NPI:** 1578801080 (Entity type: Organization)
- **Enumerated:** January 18, 2013
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **Organization subpart:** No
- **Authorized official:** Amin Huballah, PHYSICIAN ASSISTANT
## Practice location
- **Address:** 7526 WYOMING ST, STE# 2, Dearborn, MI 48126-1690
- **Phone:** (313) 834-4444
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Cardiovascular Disease (Cardiology)) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 30, 2014
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1578801080) · Data from the CMS NPPES public registry.