Lori Mackillop, N.P.

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

4704140266 Issued in MI

Practice address

22255 Greenfield Rd Ste 350
Southfield, MI 48075-3712

Phone

(248) 849-2710

Fax

(248) 849-4024

NPI assigned

Jul 24, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Lori Pearl Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: lmackillop442990@direct.hfhs.org

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.

• Endocrine and Metabolic Disorders Center PC

  • Endocrinology, Diabetes & Metabolism Physician
  • Shelby TWP, MI
  • NPI 1114270519
  NPD (past)

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548720000000",
    "number": "1073535308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22255 GREENFIELD RD STE 350",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480753712",
            "telephone_number": "248-849-2710",
            "fax_number": "248-849-4024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22255 GREENFIELD RD STE 350",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480753712",
            "telephone_number": "248-849-2710",
            "fax_number": "248-849-4024"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "135 Barclay Cir",
            "address_2": "Suite 104",
            "address_purpose": "LOCATION",
            "city": "Rochester Hills",
            "state": "MI",
            "postal_code": "483074599",
            "country_code": "US",
            "telephone_number": "248-853-7270",
            "fax_number": "248-853-7230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACKILLOP",
        "first_name": "LORI",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-24",
        "last_updated": "2019-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704140266",
            "primary": false
        },
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "MI",
            "license": "4704140266",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MI",
            "license": "4704140266",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP#",
            "identifier": "110F324280",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LORI",
            "last_name": "PEARL",
            "credential": "N.P.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Christian E Machado, MD
• Desmond Mack
• Kamryn Alice Mack, PA-C
• Levi Mack
• Tyler Mackie
• Gordon E. Mackinnon, PH. D.
• Seth Macomber
• Rachel Alexandra Macpherson, TLLP
• Amita Madan, DNP, PMHNP-BC
• Kaley Madden

• Adult Health Nurse Practitioner in Southfield, MI
• Providers in Southfield, MI by specialty
• Adult Health Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.