Individual provider Active NPI

Royda Abdo Elmathil, PA-C

  • Physician Assistant
  • Ann Arbor, MI
National Provider Identifier
1417462086
Registry record updated Dec 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601008450 Issued in MI
Practice address
1500 E Medical Center Dr
B1 Floor University Hospital Recp C
Ann Arbor, MI 48109-5030
Phone
(734) 936-4500
NPI assigned
Dec 5, 2017
Last updated
Dec 11, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2018

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 5601008450 MI Primary
Medical Physician Assistant 363AM0700X 5601008450 MI

Addresses

Primary practice location

1500 E Medical Center Dr
B1 Floor University Hospital Recp C
Ann Arbor, MI 48109-5030

Mailing address

3621 S State St
Ann Arbor, MI 48108-1633
Phone (734) 647-5299

Other practice location 1

5280 Oakman Blvd
Dearborn, MI 48126-4044
Phone (313) 846-1997

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171208001374 MI Practitioner - Physician Assistant 9931466406 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

7500 Challis Rd
Brighton, MI 48116-9416
Phone (810) 263-4000

8001 Challis Rd
Brighton, MI 48116-7446
Phone (810) 227-9510

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601008450MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Michigan Physician Assistant CurrentSince Feb 13, 2018 Accepting new patients
Regents of the University of Michigan CurrentSince Feb 13, 2018 Accepting new patients
Regents of the University of Michigan Past Accepting new patients

Locations

1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280

1500 E Medical Center Dr
#B1
Ann Arbor, MI 48109
Phone (734) 936-4500

1500 E Medical Center Dr
Fl Cancer
Ann Arbor, MI 48109
Phone (734) 647-8902

1801 Briarwood Cir
Ann Arbor, MI 48108
Phone (734) 539-5000

3621 S State St
Ann Arbor, MI 48108
Phone (734) 647-5229

8001 Challis Rd
Brighton, MI 48116
Phone (810) 227-9510

Organizations & group practices 4

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 1

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": "1512432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544486400000",
    "number": "1417462086",
    "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",
            "address_2": "B1 FLOOR UNIVERSITY HOSPITAL RECP C",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095030",
            "telephone_number": "734-936-4500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5280 Oakman Blvd",
            "address_purpose": "LOCATION",
            "city": "Dearborn",
            "state": "MI",
            "postal_code": "481264044",
            "country_code": "US",
            "telephone_number": "313-846-1997",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELMATHIL",
        "first_name": "ROYDA",
        "middle_name": "ABDO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-05",
        "last_updated": "2018-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601008450",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601008450",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.