NPIMap

Individual provider Active NPI

Fadi H Delly, M.D.

  • Interventional Pain Medicine Physician
  • Wyandotte, MI
National Provider Identifier
1104137967
Registry record updated Dec 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
4301094922 Issued in MI
Practice address
2211 Fort St
Wyandotte, MI 48192-4135
Phone
(734) 357-0505
Fax
(734) 357-0506
NPI assigned
Jun 27, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 28, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine Physician 208VP0014X 4301094922 MI Primary
Neurology Physician 2084N0400X 4301094922 MI

Addresses

Primary practice location

2211 Fort St
Wyandotte, MI 48192-4135

Mailing address

2211 Fort St
Wyandotte, MI 48192-4135
Phone (734) 357-0505

Other identifiers 1

IdentifierTypeStateIssuer
4301094922OtherMIMEDICAL LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address fdelly361209@direct.hfhs.org Henry Ford Wyandotte Hospital

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
I20140529001178 MI Practitioner - NeurologyPractitioner - Pain ManagementPractitioner - Neurosurgery 4183847767 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NeurologyAlso: Pain Management
Education
Wayne State University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fadi Delly, MD PCGroup PAC ID 1052616273, 5 clinicians

Practice addresses (Care Compare)

2211 Fort St
Wyandotte, MI 48192-4135
Phone (734) 357-0505

Hospital & facility affiliations

  • Advantage Homecare Home health agency, Wyandotte, MI, CCN 237592
  • Wyandotte Hospital and Medical Center Hospital, Wyandotte, MI, CCN 230146
  • Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053
  • Corewell Health Trenton Hospital Hospital, Trenton, MI, CCN 230176
  • Beaumont Hospital - Taylor Hospital, Taylor, MI, CCN 230270
  • Beaumont Hospital - Dearborn Hospital, Dearborn, MI, CCN 230020

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
W.a. Foote Memorial Hospital, Inc CurrentSince Dec 23, 2014 Accepting new patients
Wa Foote Memorial Hospital, Inc CurrentSince Dec 23, 2014 Accepting new patients
Step Up Physical Therapy LLC CurrentSince Jan 1, 2021 Accepting new patients
Fadi Delly, MD PC Neurology CurrentSince Oct 30, 2015 Accepting new patients
W. a. Foote Memorial Hospital, Inc Current Accepting new patients

Locations

813 W Michigan Ave
Jackson, MI 49202
Phone (517) 205-1000

15750 Northline Rd
Southgate, MI 48195
Phone (248) 798-3130

2211 Fort St
Wyandotte, MI 48192
Phone (734) 246-5705

Interoperability endpoints

  • Direct secure messaging: fdelly361209@direct.hfhs.org
  • Direct secure messaging: fdelly@direct.dmc.org

Organizations & group practices 5

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.

Hospital & facility affiliations 8

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": "1277596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609113600000",
    "number": "1104137967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 FORT ST",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481924135",
            "telephone_number": "734-357-0505",
            "fax_number": "734-357-0506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 FORT ST",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481924135",
            "telephone_number": "734-357-0505",
            "fax_number": "734-357-0506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELLY",
        "first_name": "FADI",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-27",
        "last_updated": "2020-12-28",
        "certification_date": "2020-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "MI",
            "license": "4301094922",
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301094922",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "4301094922",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "fdelly361209@direct.hfhs.org",
            "affiliation": "Y",
            "affiliationName": "Henry Ford Wyandotte Hospital",
            "address_1": "2211 Fort St",
            "city": "Wyandotte",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481924135",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wyandotte, MI

Sources for this page

Verify at the official NPI Registry.