Individual provider Active NPI

Nicholas Lance Deglopper, PA-C

  • Physician Assistant
  • Norfolk, VA
National Provider Identifier
1124746409
Registry record updated Mar 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601012131 Issued in MI
Practice address
830 Kempsville Rd
Norfolk, VA 23502-3920
Phone
(757) 261-6000
NPI assigned
Aug 22, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 5601012131 MI Primary

Addresses

Primary practice location

830 Kempsville Rd
Norfolk, VA 23502-3920

Mailing address

907 Sunset Hills Ave NW
Grand Rapids, MI 49534-3639
Phone (616) 915-7160

Other practice location 1

1234 Napier Ave
Saint Joseph, MI 49085-2112
Phone (269) 985-4632

Other practice location 2

31 N Saint Joseph Ave
Niles, MI 49120-2207
Phone (269) 985-4632

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, MI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20221101002946 VA Practitioner - Physician Assistant 3072980234 Reassigns benefits to 1 organization
I20240320003431 MI Practitioner - Physician Assistant 3072980234 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeland Medical PracticesGroup PAC ID 1658427042, 286 clinicians

Practice addresses (Care Compare)

1234 Napier Ave
Saint Joseph, MI 49085-2112
Phone (269) 983-8300

31 N Saint Joseph Ave
Niles, MI 49120-2207
Phone (269) 687-1436

3950 Hollywood Rd
Saint Joseph, MI 49085-9151

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601012131MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeland Medical Practices CurrentSince Mar 17, 2025 Accepting new patients
Bayview Physician Services, PC CurrentSince Oct 1, 2022 Accepting new patients
Sound Inpatient Physicians-Michigan, PLLC Physician Assistant CurrentSince Mar 1, 2024 Accepting new patients
Bayview Physician Services, PC CurrentSince Oct 1, 2022 Accepting new patients
Lakeland Medical Practices Past Accepting new patients

Locations

580 W College Ave
Marquette, MI 49855
Phone (906) 225-3131

31 N Saint Joseph Ave
Niles, MI 49120
Phone (269) 428-2417

3950 Hollywood Rd
Ste 280
Saint Joseph, MI 49085
Phone (269) 408-0990

1234 Napier Ave
Saint Joseph, MI 49085
Phone (269) 982-4941

120 Brentwood Commons Way
Ste 510
Brentwood, TN 37027
Phone (253) 682-6040

3241 Western Branch Blvd
Ste A
Chesapeake, VA 23321

111 Mill Creek Pkwy
Chesapeake, VA 23323
Phone (757) 558-8210

Interoperability endpoints

  • Direct secure messaging: ndeglopper3209057@epic00.corewelldirect.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 1

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": "1661126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742947200000",
    "number": "1124746409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 SUNSET HILLS AVE NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495343639",
            "telephone_number": "616-915-7160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 KEMPSVILLE RD",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235023920",
            "telephone_number": "757-261-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1234 Napier Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Joseph",
            "state": "MI",
            "postal_code": "490852112",
            "country_code": "US",
            "telephone_number": "269-985-4632",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "31 N Saint Joseph Ave",
            "address_purpose": "LOCATION",
            "city": "Niles",
            "state": "MI",
            "postal_code": "491202207",
            "country_code": "US",
            "telephone_number": "269-985-4632",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEGLOPPER",
        "first_name": "NICHOLAS",
        "middle_name": "LANCE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-22",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601012131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norfolk, VA

Sources for this page

Verify at the official NPI Registry.