NPIMap

Individual provider Active NPI

Emily Johanna Lucassian

  • Physician Assistant
  • Clinton TWP, MI
National Provider Identifier
1003439126
Registry record updated Mar 3, 2025
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Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601010141 Issued in MI
Practice address
15717 15 Mile Rd
Clinton TWP, MI 48035-2101
Phone
(586) 285-3800
NPI assigned
May 22, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 5601010141 MI Primary

Addresses

Primary practice location

15717 15 Mile Rd
Clinton TWP, MI 48035-2101

Mailing address

1 Ford PL Ste 3a
Detroit, MI 48202-3450
Phone (313) 874-4806

Other practice location 1

1225 S Latson Rd
Howell, MI 48843-7643
Phone (517) 338-2370

Other practice location 2

110 E 2nd St
Royal Oak, MI 48067-2694
Phone (800) 653-6568

Other practice location 3

3300 E Jefferson Ave Ste 100
Detroit, MI 48207-4489
Phone (313) 656-1618

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201019000208 MI Practitioner - Physician Assistant 9032539770 Reassigns benefits to 11 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601010141MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Taylor Urgent Care PC CurrentSince Oct 1, 2020 Accepting new patients
Henry Ford Health System CurrentSince Mar 1, 2025 Accepting new patients
Henry Ford Health System Physician Assistant CurrentSince Mar 1, 2025 Accepting new patients
Henry Ford Health System Past Accepting new patients
Henry Ford Maplegrove Center Past Accepting new patients
Farmington Hills Urgent Care Walk-in Clinic PC PastSince Jul 31, 2022 Accepting new patients

Locations

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

1 Ford Pl
Ste 3A
Detroit, MI 48202
Phone (313) 874-2892

110 E 2nd St
Royal Oak, MI 48067
Phone (248) 546-2110

23234 Ecorse Rd
Taylor, MI 48180
Phone (313) 292-8400

Interoperability endpoints

  • Direct secure messaging: elucassian1139601@direct.hfhs.org

Organizations & group practices 15

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1003439126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 FORD PL STE 3A",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023450",
            "telephone_number": "313-874-4806",
            "fax_number": "313-876-1305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15717 15 MILE RD",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480352101",
            "telephone_number": "586-285-3800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1225 S Latson Rd",
            "address_purpose": "LOCATION",
            "city": "Howell",
            "state": "MI",
            "postal_code": "488437643",
            "country_code": "US",
            "telephone_number": "517-338-2370",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "110 E 2nd St",
            "address_purpose": "LOCATION",
            "city": "Royal Oak",
            "state": "MI",
            "postal_code": "480672694",
            "country_code": "US",
            "telephone_number": "800-653-6568",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3300 E Jefferson Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482074489",
            "country_code": "US",
            "telephone_number": "313-656-1618",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUCASSIAN",
        "first_name": "EMILY",
        "middle_name": "JOHANNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-22",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601010141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton TWP, MI

Sources for this page

Verify at the official NPI Registry.