Organization Active NPI

Stony Creek Dermatology PLLC

  • Dermatology Physician
  • Shelby TWP, MI
National Provider Identifier
1134088164
Registry record updated Jun 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
STONY CREEK DERMATOLOGY PLLC
Practice address
52915 Mound Rd
Shelby TWP, MI 48316-3266
Phone
(800) 290-5282
Fax
(937) 534-0166
NPI assigned
Jan 16, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2026

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

Authorized official

Name
Elizabeth Messenger, MDNPI 1093248783
Title
President
Phone
(586) 786-8850

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

52915 Mound Rd
Shelby TWP, MI 48316-3266

Mailing address

52915 Mound Rd
Shelby TWP, MI 48316-3266
Phone (586) 786-8850

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260321000104 MI Part B Supplier - Clinic/Group Practice 3072097666 Receives reassigned benefits from 1 practitioner
Practice locations: Shelby TWP, MI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2343717Stony Creek Dermatology PLLC52915 Mound Road, Shelby Township, MI 48316Provider-performed microscopyMay 11, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1768521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782691200000",
    "number": "1134088164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52915 MOUND RD",
            "city": "SHELBY TWP",
            "state": "MI",
            "postal_code": "483163266",
            "telephone_number": "586-786-8850",
            "fax_number": "586-786-8851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52915 MOUND RD",
            "city": "SHELBY TWP",
            "state": "MI",
            "postal_code": "483163266",
            "telephone_number": "800-290-5282",
            "fax_number": "937-534-0166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONY CREEK DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-16",
        "last_updated": "2026-06-29",
        "certification_date": "2026-06-29",
        "status": "A",
        "authorized_official_last_name": "MESSENGER",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-786-8850",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby TWP, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2026; 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.