Gina Marie Lacolla, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601010201 Issued in MI

Practice address

1255 N Oakland Blvd
Waterford, MI 48327-1545

Phone

(248) 599-8999

Fax

(248) 406-0107

NPI assigned

Sep 21, 2020

Last updated

Dec 26, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: glacolla630609@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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Community Programs, Inc.

  dba Meridian Health Services

  • Methadone Clinic
  • Waterford, MI
  • NPI 1578014940
  Medicare reassignment
• Community Programs Inc.

  dba Meridian Health Services

  • Substance Abuse Rehabilitation Facility
  • Waterford, MI
  • NPI 1003247362
  NPD (past)
• Garden City Urgent Care PLLC

  • Urgent Care Clinic/Center
  • Garden City, MI
  • NPI 1154846145
  NPD (past)

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

{
    "created_epoch": "1600646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735171200000",
    "number": "1497361752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "523 MEADOWDALE ST",
            "city": "FERNDALE",
            "state": "MI",
            "postal_code": "482202446",
            "telephone_number": "586-744-6794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 N OAKLAND BLVD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483271545",
            "telephone_number": "248-599-8999",
            "fax_number": "248-406-0107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACOLLA",
        "first_name": "GINA",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-21",
        "last_updated": "2024-12-26",
        "certification_date": "2024-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601010201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaine Krzykwa, DOULA
• Ewa Anna Kubicz, LMSW
• Navneet Kumar, M.D.
• L & L Resources LLC (L & L Recovery)
• Tammie L Laboda, CPRC CPRM
• Yvonne Marie Lacrosse
• Cheryl Marie Lacy, A.P.R.N., B.C.
• Christine R Ladronka, LMSW
• Lake Diagnostics, Inc.
• Lake Diagnostics, Inc.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.