Individual provider Active NPI

Melanie Dawn Nelson, PHD CCC-A

  • Audiologist
  • Mt Pleasant, MI
National Provider Identifier
1174569503
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
MN000150 Issued in MI
Practice address
1101 Health Professions Building
Mt Pleasant, MI 48859-0001
Phone
(989) 774-1322
Fax
(989) 774-1891
NPI assigned
Jun 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X MN000150 MI Primary

Addresses

Primary practice location

1101 Health Professions Building
Mt Pleasant, MI 48859-0001

Mailing address

1101 Health Professions Building
Mt Pleasant, MI 48859-0001
Phone (989) 774-1322

Other identifiers 2

IdentifierTypeStateIssuer
MN000150OtherMISTATE LICENSE NUMBER
MN042984OtherMIASHA LICENCE

Other names 1

  • Melanie Dawn Ottley Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051128000404 MI Practitioner - Qualified Audiologist 5991725657 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MN000150MIMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Central Michigan University Current Accepting new patients
Central Michigan University CurrentSince Apr 1, 2005 Accepting new patients
Central Michigan University CurrentSince Apr 1, 2005 Accepting new patients

Locations

1101 Health Professions
Mount Pleasant, MI 48859
Phone (989) 774-2597

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1174569503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 HEALTH PROFESSIONS BUILDING",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488590001",
            "telephone_number": "989-774-1322",
            "fax_number": "989-774-1891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 HEALTH PROFESSIONS BUILDING",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488590001",
            "telephone_number": "989-774-1322",
            "fax_number": "989-774-1891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "MELANIE",
        "middle_name": "DAWN",
        "credential": "PHD CCC-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-22",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MI",
            "license": "MN000150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "MN000150",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASHA LICENCE",
            "identifier": "MN042984",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELANIE",
            "last_name": "OTTLEY",
            "middle_name": "DAWN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mt Pleasant, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.