Individual provider Active NPI

Michele Lucassian, DC

  • Chiropractor
  • Wyoming, MI
National Provider Identifier
1104315613
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301401265 Issued in MI
Practice address
1027 Gezon Pkwy SW
Wyoming, MI 49509-9542
Phone
(616) 301-8300
NPI assigned
May 10, 2018
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CHIR010043 GA
Chiropractor 111N00000X 2301401265 MI Primary

Addresses

Primary practice location

1027 Gezon Pkwy SW
Wyoming, MI 49509-9542

Mailing address

1027 Gezon Pkwy SW
Wyoming, MI 49509-9542
Phone (616) 301-8300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220721003296 MI Practitioner - Chiropractic 1850635251 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Sherman College of Straight Chiropractic, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Higher Health Chiropractic IncGroup PAC ID 0840428769, 5 clinicians

Practice addresses (Care Compare)

1027 Gezon Pkwy SW
Wyoming, MI 49509-9542
Phone (616) 301-8300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2301401265MIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Higher Health Chiropractic Inc Chiropractor CurrentSince Jun 16, 2022 Accepting new patients

Locations

180 Baldwin St
Ste 101
Jenison, MI 49428
Phone (616) 574-2871

1027 Gezon Pkwy SW
Wyoming, MI 49509
Phone (616) 301-4961

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1525910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1104315613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1027 GEZON PKWY SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495099542",
            "telephone_number": "616-301-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1027 GEZON PKWY SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495099542",
            "telephone_number": "616-301-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCASSIAN",
        "first_name": "MICHELE",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-10",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR010043",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301401265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyoming, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.