Michelle L Mardegian, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601002219 Issued in MI

Practice address

19401 Hubbard Dr
Dearborn, MI 48126-2641

Phone

(313) 982-8100

NPI assigned

Mar 20, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Specialty

Physician Assistant

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Henry Ford Health West Bloomfield Hospital Hospital, W Bloomfield, MI, CCN 230302
• Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mmardegian248116@direct.hfhs.org

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.

• Henry Ford Health System

  • Physician Assistant
  • Detroit, MI
  • NPI 1811073901
  Medicare reassignment Care Compare group NPD
• Michigan Otolaryngology Surgery

  • Otolaryngology Physician
  • Ypsilanti, MI
  • NPI 1407987688
  Medicare reassignment
• Wa Foote Memorial Hospital, Inc

  • Nurse Practitioner
  • Jackson, MI
  • NPI 1629000708
  Medicare reassignment
• Henry Ford Health System

  • Community/Retail Pharmacy
  • Plymouth, MI
  • NPI 1942931720
  NPD
• Michigan Otolaryngolgy Surgery

  • Audiologist-Hearing Aid Fitter
  • Ypsilanti, MI
  • NPI 1760572978
  NPD
• W.a. Foote Memorial Hospital, Inc

  • Nurse Practitioner
  • Jackson, MI
  • NPI 1366988347
  NPD
• W.a. Foote Memorial Hospital, Inc

  • Physician Assistant
  • Jackson, MI
  • NPI 1538606348
  NPD
• Henry Ford Maplegrove Center

  • Children's Substance Abuse Rehabilitation Facility
  • West Bloomfield, MI
  • NPI 1295767630
  NPD (past)
• Wa Foote Memorial Hospital, Inc

  • Emergency Medicine Physician
  • Jackson, MI
  • NPI 1265487722

  Physician Assistant

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Henry Ford Health System

  • General Acute Care Hospital
  • Detroit, MI
  • NPI 1134144801
  Care Compare affiliation
• Henry Ford Health System

  • General Acute Care Hospital
  • West Bloomfield, MI
  • NPI 1407867559
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690761600000",
    "number": "1457476129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 FORD PL STE 3A",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023450",
            "telephone_number": "313-874-4806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19401 HUBBARD DR",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262641",
            "telephone_number": "313-982-8100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5333 McAuley Dr",
            "address_2": "Ste 2017",
            "address_purpose": "LOCATION",
            "city": "Ypsilanti",
            "state": "MI",
            "postal_code": "481971014",
            "country_code": "US",
            "telephone_number": "734-434-3200 x1119",
            "fax_number": "734-434-3209",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARDEGIAN",
        "first_name": "MICHELLE",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-20",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601002219",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601002219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI LICENSE NUMBER",
            "identifier": "MM002219",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John L Marcon
• Daylonna Marcum
• John Michael Marcum
• Samantha Renee Marcum
• Andrew L Marcus, M.D.
• Leanne Kathleen Marentay, MA, CCC-SLP
• Alyssa Nicole Margetson
• Raquel Renee Marhaba
• Maria Kossak DO PLLC
• Marianne L Baran DDS PC

• Physician Assistant in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.