Individual provider Active NPI

Tracey M Sperry, D.O.

  • Internal Medicine Physician
  • Canton, MI
National Provider Identifier
1043369523
Registry record updated Oct 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5101011328 Issued in MI
Practice address
49650 Cherry Hill Road
Suite 120
Canton, MI 48187
Phone
(734) 398-7800
Fax
(734) 398-7805
NPI assigned
Jan 10, 2007
Last updated
Oct 27, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 5101011328 MI Primary

Addresses

Primary practice location

49650 Cherry Hill Road
Suite 120
Canton, MI 48187

Mailing address

24 Frank Lloyd Wright Drive
P.O. Box 0446, Lobby J
Ann Arbor, MI 48106-0446

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041012000189 MI Practitioner - Internal Medicine 6204817737 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Michigan State University College of Osteopathic Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iha Olma Primary Care Risk LLCGroup PAC ID 1153733324, 26 clinicians
Iha Health Services CorporationGroup PAC ID 2466351440, 1,149 clinicians

Practice addresses (Care Compare)

19000 St Joes Pkwy
Suite 200
Livonia, MI 48152-1477
Phone (734) 213-3685

20555 Victor Pkwy
Livonia, MI 48152-7031

37595 7 Mile Rd
Suite 340
Livonia, MI 48152-1489
Phone (734) 793-2470

49650 Cherry Hill Rd
Suite 120
Canton, MI 48187-4850
Phone (734) 398-7800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Olma Primary Care Risk LLC Internal Medicine CurrentSince May 23, 2024 Accepting new patients
Iha Health Services Corporation Current Accepting new patients
Iha Olma Primary Care Risk LLC Internal Medicine CurrentSince May 23, 2024 Accepting new patients
Iha Health Services Corporation Internal Medicine CurrentSince Jul 1, 2009 Accepting new patients
Iha Health Service Corporation CurrentSince Jul 1, 2009 Accepting new patients
McLaren Macomb Internal Medicine Past Accepting new patients

Locations

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

49650 Cherry Hill Rd
Ste 120
Canton, MI 48187
Phone (734) 398-7800

128 Van Buren St
Chelsea, MI 48118
Phone (734) 475-8677

37595 7 Mile Rd
Ste 340
Livonia, MI 48152
Phone (734) 542-9999

Organizations & group practices 6

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

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319673600000",
    "number": "1043369523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 FRANK LLOYD WRIGHT DRIVE",
            "address_2": "P.O. BOX 0446, LOBBY J",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481060446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49650 CHERRY HILL ROAD",
            "address_2": "SUITE 120",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "48187",
            "telephone_number": "734-398-7800",
            "fax_number": "734-398-7805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPERRY",
        "first_name": "TRACEY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-10",
        "last_updated": "2011-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101011328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MI

Sources for this page

Verify at the official NPI Registry.