Lori Marcum Fedoronko

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

4301064064 Issued in MI

Practice address

1350 Kirts Blvd
Suite 155
Troy, MI 48084-4851

Phone

(248) 362-0222

Fax

(248) 362-1165

NPI assigned

Oct 27, 2005

Last updated

Sep 6, 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

Other identifiers 1

Other names 1

• Lori Irene Fedoronko Former name

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

Specialty

Dermatology

Education

Wayne State University School of Medicine, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Lori Fedoronko M D P C

  • Procedural Dermatology Physician
  • Troy, MI
  • NPI 1265633416
  Medicare reassignment NPD Authorized official

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

• William Beaumont Hospital

  dba Beaumont Hospital, Troy

  • General Acute Care Hospital
  • Troy, MI
  • NPI 1306825997
  Care Compare affiliation
• William Beaumont Hospital

  dba Beaumont Hospital, Royal Oak

  • General Acute Care Hospital
  • Royal Oak, MI
  • NPI 1689653305
  Care Compare affiliation
• William Beaumont Hospital

  dba Beaumont Hospital, Grosse Pointe

  • General Acute Care Hospital
  • Grosse Pointe, MI
  • NPI 1932396017
  Care Compare affiliation

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

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1548250855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 KIRTS BLVD",
            "address_2": "SUITE 155",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480844851",
            "telephone_number": "248-362-0222",
            "fax_number": "248-362-1165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 KIRTS BLVD",
            "address_2": "SUITE 155",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480844851",
            "telephone_number": "248-362-0222",
            "fax_number": "248-362-1165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDORONKO",
        "first_name": "LORI",
        "middle_name": "MARCUM",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-27",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "4301064064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3415994",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LORI",
            "last_name": "FEDORONKO",
            "middle_name": "IRENE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Dema Fawaz, MD
• Zubair Fayyaz, PT, DPT
• Muhammad Fazal, PT
• Nicole Marie Fecteau, OTRL
• Federal Medical Services PC
• Jennifer Felarca
• Lindsey Feldman, DO
• Iryl Felicidario
• Kristen E Felipe-Ortega
• Jennifer Ann Felix, L.L.P.

• Dermatology Physician in Troy, MI
• Providers in Troy, MI by specialty
• Dermatology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 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.
• 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.