Individual provider Active NPI

Micah Lissy, MD

  • Sports Medicine (Orthopaedic Surgery) Physician
  • East Lansing, MI
National Provider Identifier
1154627370
Registry record updated Jul 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
4301099989 Issued in MI
Practice address
4660 S Hagadorn Rd Ste 420
East Lansing, MI 48823-5353
Phone
(517) 884-6100
Fax
(517) 884-6233
NPI assigned
Feb 4, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 261158 NY
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 4301099989 MI Primary

Addresses

Primary practice location

4660 S Hagadorn Rd Ste 420
East Lansing, MI 48823-5353

Mailing address

804 Service Rd Ste A109B
East Lansing, MI 48824-7015
Phone (517) 884-6100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, MI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130531000455 NY Practitioner - Orthopedic Surgery 3173761285 Reassigns benefits to 2 organizations
I20220729000692 MI Practitioner - Orthopedic Surgery 3173761285 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Msu Health Care Inc.Group PAC ID 8628404936, 201 clinicians

Practice addresses (Care Compare)

4660 S Hagadorn Rd
East Lansing, MI 48823-5353

4660 S Hagadorn Rd
Suite 500
East Lansing, MI 48823-6804
Phone (517) 884-4554

Hospital & facility affiliations

  • McLaren Greater Lansing Hospital, Lansing, MI, CCN 230167
  • Edward W Sparrow Hospital Hospital, Lansing, MI, CCN 230230

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301099989MIMDSports Medicine (Orthopaedic Surgery) Physician
261158NYMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
United Health Services Hospitals, Inc. CurrentSince Jun 1, 2013 Accepting new patients
United Medical Associates PC CurrentSince Jan 3, 2022 Accepting new patients
United Medical Associates, P.C. CurrentSince Jan 3, 2022 Accepting new patients
Msu Health Care Inc. CurrentSince Aug 15, 2022 Accepting new patients
Msu Health Care Inc. Sports Medicine CurrentSince Aug 15, 2022 Accepting new patients
Msu Health Care Inc Current Accepting new patients
Msu Health Care Inc. Past Accepting new patients

Locations

804 Service Rd
Ste A109B
East Lansing, MI 48824
Phone (517) 884-2976

4660 S Hagadorn Rd
Ste 420
East Lansing, MI 48823
Phone (517) 884-6100

4650 S Hagadorn Rd
Ste 100
East Lansing, MI 48823
Phone (517) 353-4830

4660 S Hagadorn Rd
Ste 500
East Lansing, MI 48823
Phone (517) 432-6144

8836 State Route 434
Apalachin, NY 13732
Phone (607) 625-4151

33 Mitchell Ave
Ste G50
Binghamton, NY 13903
Phone (607) 771-2220

33 Mitchell Ave
#G50
Binghamton, NY 13903
Phone (607) 771-2220

33-57 Harrison St
Johnson City, NY 13790
Phone (607) 763-6412

346 Grand Ave
Johnson City, NY 13790
Phone (607) 729-8156

4433 Vestal Pkwy E
Vestal, NY 13850
Phone (607) 762-2176

Interoperability endpoints

  • Direct secure messaging: micah.lissy.1@25394.direct.athenahealth.com

Organizations & group practices 7

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 3

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": "1296777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658793600000",
    "number": "1154627370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 SERVICE RD STE A109B",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247015",
            "telephone_number": "517-884-6100",
            "fax_number": "517-884-6233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4660 S HAGADORN RD STE 420",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488235353",
            "telephone_number": "517-884-6100",
            "fax_number": "517-884-6233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISSY",
        "first_name": "MICAH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-02-04",
        "last_updated": "2022-07-26",
        "certification_date": "2022-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "NY",
            "license": "261158",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "MI",
            "license": "4301099989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Lansing, MI

Sources for this page

Verify at the official NPI Registry.