Individual provider Active NPI

Jaime Lynn Dreyer-Laezza, M.D.

  • Pediatrics Physician
  • Troy, MI
National Provider Identifier
1467660779
Registry record updated Nov 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4301087960 Issued in MI
Practice address
44199 Dequindre Rd
Suite 222
Troy, MI 48085-1128
Phone
(248) 879-5570
NPI assigned
May 18, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 14, 2019

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 4301087960 MI Primary

Addresses

Primary practice location

44199 Dequindre Rd
Suite 222
Troy, MI 48085-1128

Mailing address

633 South Blvd E Ste 2400
Rochester Hills, MI 48307-5471
Phone (248) 879-5570

Other practice location 1

50720 Schoenherr Road
Shelby Township, MI 48315-1128
Phone (586) 566-2340

Other practice location 2

633 E. South Blvd Suite 2400
Rochester Hills, MI 48307-1128
Phone (248) 879-5570

Other identifiers 1

IdentifierTypeStateIssuer
1467660779MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Consultants of Troy, P.C. Pediatrics CurrentSince Oct 31, 2021 Accepting new patients

Locations

633 South Blvd E
Ste 2400
Rochester Hills, MI 48307
Phone (248) 879-5570

50720 Schoenherr Rd
Shelby Township, MI 48315
Phone (586) 566-2340

44199 Dequindre Rd
Ste 222
Troy, MI 48085
Phone (248) 879-5570

Interoperability endpoints

  • Direct secure messaging: jaime.dreyer-laezza.1@14995.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/14995/brand/1/csg/1/fhir/r4

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573689600000",
    "number": "1467660779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 SOUTH BLVD E STE 2400",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483075471",
            "telephone_number": "248-879-5570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44199 DEQUINDRE RD",
            "address_2": "SUITE 222",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480851128",
            "telephone_number": "248-879-5570"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "50720 Schoenherr Road",
            "address_purpose": "LOCATION",
            "city": "Shelby Township",
            "state": "MI",
            "postal_code": "483151128",
            "country_code": "US",
            "telephone_number": "586-566-2340",
            "fax_number": "586-566-4425",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "633 E. South Blvd Suite 2400",
            "address_purpose": "LOCATION",
            "city": "Rochester Hills",
            "state": "MI",
            "postal_code": "483071128",
            "country_code": "US",
            "telephone_number": "248-879-5570",
            "fax_number": "248-879-2235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DREYER-LAEZZA",
        "first_name": "JAIME",
        "middle_name": "LYNN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-18",
        "last_updated": "2019-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301087960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1467660779",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Troy, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.