NPIMap

Individual provider Active NPI

Laura Kathleen Dalla Vecchia, M.D.

  • Surgery Physician
  • Clinton Township, MI
National Provider Identifier
1083775407
Registry record updated Dec 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
4301075676 Issued in MI
Practice address
43331 Commons Dr
Clinton Township, MI 48038-1109
Phone
(586) 263-5410
Fax
(586) 263-7131
NPI assigned
Dec 12, 2006
Last updated
Dec 18, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 4301075676 MI Primary

Addresses

Primary practice location

43331 Commons Dr
Clinton Township, MI 48038-1109

Mailing address

43331 Commons Dr
Clinton Township, MI 48038-1109
Phone (586) 263-5410

Other identifiers 2

IdentifierTypeStateIssuer
1316031339OtherMIGROUP NPI
4856287MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ldallavecchia248899@direct.hfhs.org Henry Ford Macomb Hospital Corporation

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
I20040115000285 MI Practitioner - General Surgery 2062313935 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Wayne State University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

15855 19 Mile Rd
Clinton Township, MI 48038-3504
Phone (586) 263-2300

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 916-2600

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy63
Melanoma (skin cancer) excision1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Macomb Hospital Corporation CurrentSince Oct 28, 2022 Accepting new patients
Henry Ford Health System Current Accepting new patients
Henry Ford Macomb Hospital Corporation Current Accepting new patients
Henry Ford Wyandotte Hospital CurrentSince Oct 28, 2022 Accepting new patients
Henry Ford Wyandotte Hospital CurrentSince Oct 28, 2022 Accepting new patients
Henry Ford Health System Surgery CurrentSince Oct 28, 2022 Accepting new patients
Henry Ford Macomb Hospital Corporation CurrentSince Oct 28, 2022 Accepting new patients
Henry Ford Pathology Current Accepting new patients
Henry Ford Health System CurrentSince Oct 28, 2022 Accepting new patients
The Doctors Group, P.C. Past Accepting new patients
Henry Ford Wyandotte Hospital Past Accepting new patients
General Surgical Associates PC Past Accepting new patients

Locations

15855 19 Mile Rd
Clinton Twp, MI 48038
Phone (586) 263-2300

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

2070 Biddle Ave
Ste 2
Wyandotte, MI 48192
Phone (734) 284-7482

2333 Biddle Ave
Wyandotte, MI 48192
Phone (734) 246-6000

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/8ce5d363-ea3e-4f6f-a99f-e6d83ae8306f/
  • Direct secure messaging: ldallavecchia248899@direct.hfhs.org

Organizations & group practices 12

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": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608249600000",
    "number": "1083775407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43331 COMMONS DR",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480381109",
            "telephone_number": "586-263-5410",
            "fax_number": "586-263-7131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43331 COMMONS DR",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480381109",
            "telephone_number": "586-263-5410",
            "fax_number": "586-263-7131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALLA VECCHIA",
        "first_name": "LAURA",
        "middle_name": "KATHLEEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-12",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301075676",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1316031339",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4856287",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ldallavecchia248899@direct.hfhs.org",
            "affiliation": "Y",
            "affiliationName": "Henry Ford Macomb Hospital Corporation",
            "address_1": "15855 19 Mile Rd",
            "city": "Clinton Twp",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480383504",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Clinton Township, MI

Sources for this page

Verify at the official NPI Registry.