NPIMap

Individual provider Active NPI

Melissa Lukens Drallos, PA

  • Medical Physician Assistant
  • Lake Orion, MI
National Provider Identifier
1407895634
Registry record updated Jul 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
5601004538 Issued in MI
Practice address
1455 S Lapeer Rd
Suite 100
Lake Orion, MI 48360-1467
Phone
(248) 693-3551
NPI assigned
Jun 5, 2006
Last updated
Jul 18, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5601004538 MI Primary

Addresses

Primary practice location

1455 S Lapeer Rd
Suite 100
Lake Orion, MI 48360-1467

Mailing address

1455 S Lapeer Rd
Suite 100
Lake Orion, MI 48360-1467
Phone (248) 693-3551

Other identifiers 1

IdentifierTypeStateIssuer
08-5-63-1845-0OtherMIBCBS MICHIGAN

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
I20050707000470 MI Practitioner - Physician Assistant 4688610058 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Wayne State University School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Orion Family Physicians PCGroup PAC ID 0143212712, 11 clinicians

Practice addresses (Care Compare)

1455 S Lapeer Rd
Lake Orion, MI 48360-1468
Phone (248) 693-3551

Hospital & facility affiliations

National Provider Directory

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

Organizations & group practices 1

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 11

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": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216339200000",
    "number": "1407895634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1455 S LAPEER RD",
            "address_2": "SUITE 100",
            "city": "LAKE ORION",
            "state": "MI",
            "postal_code": "483601467",
            "telephone_number": "248-693-3551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 S LAPEER RD",
            "address_2": "SUITE 100",
            "city": "LAKE ORION",
            "state": "MI",
            "postal_code": "483601467",
            "telephone_number": "248-693-3551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DRALLOS",
        "first_name": "MELISSA",
        "middle_name": "LUKENS",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-05",
        "last_updated": "2008-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601004538",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MICHIGAN",
            "identifier": "08-5-63-1845-0",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Orion, MI

Sources for this page

Verify at the official NPI Registry.