Individual provider Active NPI

Karolyn Rose Coulouris, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Novi, MI
National Provider Identifier
1104522770
Registry record updated Jan 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
4704320977 Issued in MI
Practice address
39465 W 14 Mile Rd
Novi, MI 48377-1600
Phone
(877) 906-9699
NPI assigned
Feb 6, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 4704320977 MI Primary

Addresses

Primary practice location

39465 W 14 Mile Rd
Novi, MI 48377-1600

Mailing address

510 Hempstead Tpke RM 203
West Hempstead, NY 11552-1152
Phone (516) 505-7200

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230830004034 MI Practitioner - Nurse Practitioner 2860855327 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Michigan Medical School, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Behavioral Care Solutions for Adults and Seniors IncGroup PAC ID 4880918051, 71 clinicians

Practice addresses (Care Compare)

39465 W 14 Mile Rd
Novi, MI 48377-1600
Phone (877) 906-9699

Merit-based Incentive Payment System (MIPS)

Final score
57.96 of 100Reported as group
Quality
21.71
Promoting interoperability
12
Improvement activities
40
Cost
78.16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4704320977MIMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Aldad Medical PC CurrentSince Oct 1, 2023 Accepting new patients
Behavioral Care Solutions for Adults and Seniors, Inc. Psychiatric/Mental Health CurrentSince Dec 29, 2023 Accepting new patients
Aldad Medical PC CurrentSince Oct 1, 2023 Accepting new patients

Locations

2723 S State St
Ste 150
Ann Arbor, MI 48104
Phone (734) 316-7880

400 Renaissance Ctr
Ste 2600
Detroit, MI 48243
Phone (248) 599-1582

39465 W 14 Mile Rd
Novi, MI 48377
Phone 24885939000

510 Hempstead Tpke
Rm 203
West Hempstead, NY 11552
Phone 51650572001051

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1675641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705622400000",
    "number": "1104522770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 HEMPSTEAD TPKE RM 203",
            "city": "WEST HEMPSTEAD",
            "state": "NY",
            "postal_code": "115521152",
            "telephone_number": "516-505-7200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39465 W 14 MILE RD",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483771600",
            "telephone_number": "877-906-9699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COULOURIS",
        "first_name": "KAROLYN",
        "middle_name": "ROSE",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-06",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704320977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Novi, MI

Sources for this page

Verify at the official NPI Registry.