NPIMap

Organization Active NPI

Iha Olma Specialty 1 LLC

  • Surgical Critical Care Physician
  • Livonia, MI
National Provider Identifier
1114667144
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
Legal business name
IHA OLMA SPECIALTY 1 LLC
Practice address
36475 Five Mile Rd
Livonia, MI 48154-1971
Phone
(734) 655-2692
Fax
(734) 655-4218
NPI assigned
Mar 29, 2022
Last updated
Oct 9, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

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

Authorized official

Name
Cynthia A Elliott
Title
President
Phone
(734) 327-0872

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU
Surgical Critical Care Physician 2086S0102X NU Primary

Addresses

Primary practice location

36475 Five Mile Rd
Livonia, MI 48154-1971

Mailing address

24 Frank Lloyd Wright Dr Ste J2000
Ann Arbor, MI 48105-9484
Phone (734) 747-6766

Other practice location 1

14555 LeVan Rd Ste 311
Livonia, MI 48154-5085
Phone (734) 655-2692

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210617000949 MI Part B Supplier - Clinic/Group Practice 6901206689 Receives reassigned benefits from 104 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Brighton, MI; Canton, MI; Chelsea, MI; Farmington Hills, MI; Livonia, MI; Pontiac, MI; Westland, MI; Ypsilanti, MI

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Cobius Healthcare Solutions3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

14650 E Old US Highway 12
Ste 303
Chelsea, MI 48118
Phone (734) 475-4177

14555 Levan Rd
Ste 311
Livonia, MI 48154
Phone (248) 858-3850

19000 St Joes Pkwy
Ste 310
Livonia, MI 48152
Phone (248) 743-4490

36622 5 Mile Rd
Ste 202
Livonia, MI 48154
Phone (734) 655-2692

44555 Woodward Ave
Ste 501
Pontiac, MI 48341
Phone (248) 335-3101

Practitioners & affiliated clinicians

Practitioners 100

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 100

NPI Registry JSON

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

{
    "created_epoch": "1648512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696809600000",
    "number": "1114667144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 FRANK LLOYD WRIGHT DR STE J2000",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481059484",
            "telephone_number": "734-747-6766",
            "fax_number": "734-222-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36475 FIVE MILE RD",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481541971",
            "telephone_number": "734-655-2692",
            "fax_number": "734-655-4218"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14555 LeVan Rd Ste 311",
            "address_purpose": "LOCATION",
            "city": "Livonia",
            "state": "MI",
            "postal_code": "481545085",
            "country_code": "US",
            "telephone_number": "734-655-2692",
            "fax_number": "734-655-4218",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IHA OLMA SPECIALTY 1 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-29",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "734-327-0872"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livonia, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.