Annaliese Grace Khemmoro

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601012844 Issued in MI

Practice address

911 E 9 Mile Rd
Ferndale, MI 48220-1934

Phone

(248) 336-4000

Fax

(248) 336-9137

NPI assigned

Dec 6, 2024

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

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: annaliese.khemmoro.1@33060.direct.athenahealth.com

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.

• Epic Care Centers Inc

  • Family Medicine Physician
  • Hamtramck, MI
  • NPI 1659145506
  Medicare reassignment
• Exclusive Physicians PLLC

  • Multi-Specialty Clinic/Center
  • Ferndale, MI
  • NPI 1811226749
  Medicare reassignment

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

{
    "created_epoch": "1733443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765843200000",
    "number": "1548076268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18000 W 9 MILE RD STE 200",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754020",
            "telephone_number": "248-336-4000",
            "fax_number": "248-336-9137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 E 9 MILE RD",
            "city": "FERNDALE",
            "state": "MI",
            "postal_code": "482201934",
            "telephone_number": "248-336-4000",
            "fax_number": "248-336-9137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHEMMORO",
        "first_name": "ANNALIESE",
        "middle_name": "GRACE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-06",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601012844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Jeffrey Kendzorski
• Staci Kent, LLMSW
• Dima Georges Khalife, DDS
• Gurudarshan S Khalsa, M.D.
• Faraz Ahmed Khan, MD
• Haksoo Kim
• Kingswood Hospital
• Kevin Kinsel, LMSW
• Grace Harding Kirkley, NBC-HWC
• Paula Kirsch, LMSW, LCSW, CST

• Physician Assistant in Ferndale, MI
• Providers in Ferndale, 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 16, 2025; 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.