Individual provider Active NPI

Todd Thornton Lavery, M.D.

  • Surgery Physician
  • Detroit, MI
National Provider Identifier
1497995641
Registry record updated May 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
4301090570 Issued in MI
Practice address
4160 John R St Ste 615
Detroit, MI 48201-2022
Phone
(313) 745-8773
Fax
(313) 993-0595
NPI assigned
Mar 1, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 4301090570 MI Primary

Addresses

Primary practice location

4160 John R St Ste 615
Detroit, MI 48201-2022

Mailing address

1560 E Maple Rd
Suite 400- Credentialing Department
Troy, MI 48083-1138
Phone (248) 581-5974

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120816000440 MI Practitioner - General Surgery 5799931283 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Wayne State University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Physician GroupGroup PAC ID 8628087681, 399 clinicians

Practice addresses (Care Compare)

4160 John R St
Suite 615
Detroit, MI 48201-2022
Phone (313) 745-4195

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301090570MIMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Physician Group CurrentSince Jul 3, 2015 Accepting new patients
University Physician Group CurrentSince Jul 3, 2015 Accepting new patients
VHS Detroit Receiving Hospital Inc Past Accepting new patients
University Physician Group Past Accepting new patients

Locations

4160 John R St
Ste 615
Detroit, MI 48201
Phone (313) 745-5111

4100 John R St
Detroit, MI 48201
Phone (313) 576-8530

1560 E Maple Rd
Ste 400
Troy, MI 48083

1560 E Maple Rd
Ste 200
Troy, MI 48083
Phone (248) 581-5200

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 and National Provider Directory roles.

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": "1235865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430870400000",
    "number": "1497995641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 E MAPLE RD",
            "address_2": "SUITE 400- CREDENTIALING DEPARTMENT",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831138",
            "telephone_number": "248-581-5974",
            "fax_number": "248-581-5640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4160 JOHN R ST STE 615",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012022",
            "telephone_number": "313-745-8773",
            "fax_number": "313-993-0595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAVERY",
        "first_name": "TODD",
        "middle_name": "THORNTON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-01",
        "last_updated": "2015-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301090570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.