Angelique Nikkol-Telycenas Ellison, D.O.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

5101020652 Issued in MI

Practice address

5400 Fort St Ste 250
Trenton, MI 48183-4630

Phone

(734) 642-2480

Fax

(734) 642-2475

NPI assigned

Jun 11, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Obstetrics/Gynecology

Education

Michigan State University College of Osteopathic Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oakwood Ambulatory LLCGroup PAC ID 1850282914, 271 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Corewell Health Trenton Hospital Hospital, Trenton, MI, CCN 230176
• Beaumont Hospital - Dearborn Hospital, Dearborn, MI, CCN 230020
• Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: aellison119963@direct.beaumont.edu

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.

• Oakwood Ambulatory LLC

  • Internal Medicine Physician
  • Dearborn, MI
  • NPI 1003829441

  Obstetrics & Gynecology

  Medicare reassignment Care Compare group NPD
• Oakwood Ambulatory, LLC

  • Podiatrist
  • Westland, MI
  • NPI 1013157361
  NPD
• Oakwood Healthcare, Inc.

  • General Acute Care Hospital
  • Trenton, MI
  • NPI 1740230648
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Oakwood Healthcare Inc

  • Community Health Clinic/Center
  • Dearborn, MI
  • NPI 1790414670

  Hospital

  Care Compare affiliation
• Oakwood Healthcare, Inc.

  • General Acute Care Hospital
  • Dearborn, MI
  • NPI 1740230119
  Care Compare affiliation
• Oakwood Healthcare, Inc.

  • General Acute Care Hospital
  • Trenton, MI
  • NPI 1740230648
  Care Compare affiliation
• William Beaumont Hospital

  • General Acute Care Hospital
  • Troy, MI
  • NPI 1306825997
  Care Compare affiliation
• William Beaumont Hospital

  • General Acute Care Hospital
  • Royal Oak, MI
  • NPI 1689653305
  Care Compare affiliation
• William Beaumont Hospital

  • General Acute Care Hospital
  • Grosse Pointe, MI
  • NPI 1932396017
  Care Compare affiliation

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

{
    "created_epoch": "1370908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1154769214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849",
            "telephone_number": "947-522-1863",
            "fax_number": "947-522-0307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 FORT ST STE 250",
            "city": "TRENTON",
            "state": "MI",
            "postal_code": "481834630",
            "telephone_number": "734-642-2480",
            "fax_number": "734-642-2475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "ANGELIQUE",
        "middle_name": "NIKKOL-TELYCENAS",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-11",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "5101020652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aellison119963@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "5400 Fort St Ste 250",
            "city": "Trenton",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481834630",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Edp of Mi, PC
• Edward a. Blanzy DO
• Chelsea Leann Eldridge, BEHAVIOR TECHNICIAN
• Ellen G. Fredericks PHD., L.P., P.C.
• Latoya Ellis
• Caleb Gow Elsemore
• Paul Richard Emmons III, CRNA
• Emily Elizabeth- Lee England, LLBSW
• Lynn Michelle Essenmacher, RDH, BS
• Etlinger Chiropractic Clinic PC

• Obstetrics & Gynecology Physician in Trenton, MI
• Providers in Trenton, MI by specialty
• Obstetrics & Gynecology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.