Active NPI
Elizabeth Gilliam, MD
- Pediatric Surgery Physician
- Ann Arbor, MI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Surgery Physician
- License
- 4301512536
- Practice address
- 1500 E Medical Center Dr
Ann Arbor, MI 48109-5000 - Phone
- (734) 936-4000
- NPI assigned
- Apr 9, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | PG206924 | OR | |
| Surgery Physician | 208600000X | U6241 | TX | |
| Surgical Critical Care Physician | 2086S0102X | U6241 | TX | |
| Pediatric Surgery Physician | 2086S0120X | 4301512536 | MI | Primary |
Addresses
Primary practice location
1500 E Medical Center Dr
Ann Arbor, MI 48109-5000
Mailing address
3621 S State St
Ann Arbor, MI 48108-1633
Phone (734) 647-5299
Other practice location 1
6701 Fannin St
Houston, TX 77030-2608
Phone (832) 822-2778
Other practice location 2
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-8211
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX, MI
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240501001920 | TX | Practitioner - General Surgery | 3678889516 | Reassigns benefits to 1 organization |
| I20240829001652 | MI | Practitioner - General Surgery | 3678889516 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PG206924 | OR | MD | Surgery Physician |
| U6241 | TX | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regents of the University of Michigan | Surgery | Current | Accepting new patients |
| Regents of the University of Michigan | Current | Accepting new patients | |
| Regents of the University of Michigan | Current | Accepting new patients | |
| Texas Children'S Physician Group | Current | Accepting new patients | |
| Regents of the University of Michigan | Past | Accepting new patients |
Locations
1500 E Medical Center Dr
#D
Ann Arbor, MI 48109
Phone (734) 936-5823
1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280
3621 S State St
Ann Arbor, MI 48108
Phone (734) 647-5229
1500 E Medical Center Dr
Fl 4
Ann Arbor, MI 48109
Phone (734) 763-9259
6701 Fannin St
Houston, TX 77030
Phone (832) 822-1764
6651 Main St
Va Hospital, TX 77030
Phone (832) 826-3000
Organizations & group practices 5
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.
-
- Pediatric Surgery Physician
- Ann Arbor, MI
- NPI 1811922974
Surgery
-
- Specialty Pharmacy
- Dexter, MI
- NPI 1952181919
-
- General Acute Care Hospital
- Ann Arbor, MI
- NPI 1003878539
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1428537600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724025600000",
"number": "1235525932",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3621 S STATE ST",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481081633",
"telephone_number": "734-647-5299"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 E MEDICAL CENTER DR",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481095000",
"telephone_number": "734-936-4000"
}
],
"practiceLocations": [
{
"address_1": "6701 Fannin St",
"address_purpose": "LOCATION",
"city": "Houston",
"state": "TX",
"postal_code": "770302608",
"country_code": "US",
"telephone_number": "832-822-2778",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3181 SW Sam Jackson Park Rd",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "972393011",
"country_code": "US",
"telephone_number": "503-494-8211",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GILLIAM",
"first_name": "ELIZABETH",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-04-09",
"last_updated": "2024-08-19",
"certification_date": "2024-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "OR",
"license": "PG206924",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "TX",
"license": "U6241",
"primary": false
},
{
"code": "2086S0102X",
"taxonomy_group": "",
"desc": "Surgery, Surgical Critical Care",
"state": "TX",
"license": "U6241",
"primary": false
},
{
"code": "2086S0120X",
"taxonomy_group": "",
"desc": "Surgery, Pediatric Surgery",
"state": "MI",
"license": "4301512536",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.