NPIMap

Individual provider Active NPI

Jill F. Dely, PA-C

  • Physician Assistant
  • Warren, MI
National Provider Identifier
1174714372
Registry record updated Jan 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601005004 Issued in MI
Practice address
11900 E 12 Mile Rd
Suite 103
Warren, MI 48093-3400
Phone
(586) 574-0890
Fax
(586) 574-9321
NPI assigned
Aug 5, 2007
Last updated
Jan 19, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2016

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 5601005004 MI Primary
Medical Physician Assistant 363AM0700X 5601005004 MI

Addresses

Primary practice location

11900 E 12 Mile Rd
Suite 103
Warren, MI 48093-3400

Mailing address

11900 E 12 Mile Rd
Suite 103
Warren, MI 48093-3400
Phone (586) 574-0890

Other identifiers 1

IdentifierTypeStateIssuer
5601005004OtherMISTATE LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071002000382 MI Practitioner - Physician Assistant 1658466966 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

22101 Moross Rd
Detroit, MI 48236-2148
Phone (586) 753-0011

25195 Kelly Rd
Suite a
Roseville, MI 48066-5084
Phone (586) 775-4594

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601005004MIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health St. John Hospital CurrentSince Nov 18, 2019 Accepting new patients
Henry Ford Health Macomb-Oakland Hospital CurrentSince Jan 3, 2016 Accepting new patients
Henry Ford Health Macomb-Oakland Hospital CurrentSince Jan 3, 2016 Accepting new patients
Henry Ford Health St. John Hospital CurrentSince Nov 18, 2019 Accepting new patients
Lansing Cardiovascular Consultants PC Past Accepting new patients
Aajay N Shah MD PLC Medical Past Accepting new patients

Locations

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

17900 23 Mile Rd
Ste 304
Macomb, MI 48044
Phone (586) 868-9010

27483 Dequindre Rd
Ste 204
Madison Hts, MI 48071
Phone (248) 967-7326

25195 Kelly Rd
Ste A
Roseville, MI 48066
Phone (586) 775-4594

2800 Livernois Rd
Ste 500
Troy, MI 48083
Phone (586) 753-0400

44720 Van Dyke Ave
#G
Utica, MI 48317
Phone (586) 323-7148

11900 E 12 Mile Rd
Ste 103
Warren, MI 48093
Phone (586) 574-0890

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/
  • Direct secure messaging: jdely1086677@direct.hfhs.org
  • Direct secure messaging: jill.dely.2@8209.direct.athenahealth.com

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1186272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453161600000",
    "number": "1174714372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11900 E 12 MILE RD",
            "address_2": "SUITE 103",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933400",
            "telephone_number": "586-574-0890",
            "fax_number": "586-574-9321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11900 E 12 MILE RD",
            "address_2": "SUITE 103",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933400",
            "telephone_number": "586-574-0890",
            "fax_number": "586-574-9321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELY",
        "first_name": "JILL",
        "middle_name": "F.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-05",
        "last_updated": "2016-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601005004",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601005004",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "5601005004",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

Verify at the official NPI Registry.