Individual provider Active NPI

Marisa Elias, M.D.

  • Pediatrics Physician
  • Royal Oak, MI
National Provider Identifier
1326422908
Registry record updated Jun 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4301108364 Issued in MI
Practice address
110 E 2ND St
Royal Oak, MI 48067-2694
Phone
(248) 546-2110
NPI assigned
Jul 14, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 4301108364 MI Primary

Addresses

Primary practice location

110 E 2ND St
Royal Oak, MI 48067-2694

Mailing address

110 E 2ND St
Royal Oak, MI 48067-2694
Phone (248) 546-2110

Other names 1

  • Dr. Marisa Chang Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address melias500403@direct.hfhs.org

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20180724001278 MI Practitioner - Pediatric Medicine 0941516413 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301108364MIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health System Current Accepting new patients
Henry Ford Health System Pediatrics CurrentSince Jun 16, 2018 Accepting new patients
Henry Ford Health System CurrentSince Jun 16, 2018 Accepting new patients

Locations

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

110 E 2nd St
Royal Oak, MI 48067
Phone (248) 546-2110

22777 W 11 Mile Rd
Southfield, MI 48033
Phone (248) 358-0722

2825 Livernois Rd
Troy, MI 48083
Phone (248) 680-2060

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": "1436832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656028800000",
    "number": "1326422908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E 2ND ST",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480672694",
            "telephone_number": "248-546-2110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E 2ND ST",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480672694",
            "telephone_number": "248-546-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELIAS",
        "first_name": "MARISA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-14",
        "last_updated": "2022-06-24",
        "certification_date": "2022-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301108364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "melias500403@direct.hfhs.org",
            "affiliation": "N",
            "address_1": "110 E 2nd St",
            "city": "Royal Oak",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480672694",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARISA",
            "last_name": "CHANG",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Royal Oak, MI

Sources for this page

Verify at the official NPI Registry.