Individual provider Active NPI

Laurie K McCauley, DMD PHD

  • Periodontics
  • Ann Arbor, MI
National Provider Identifier
1598898744
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
2901016012 Issued in MI
Practice address
1011 N University Ave
Ann Arbor, MI 48109-1078
Phone
(734) 764-1562
Fax
(734) 763-3389
NPI assigned
Mar 14, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2901016012 MI
Periodontics 1223P0300X 2901016012 MI Primary

Addresses

Primary practice location

1011 N University Ave
Ann Arbor, MI 48109-1078

Mailing address

1011 N University Ave
Ann Arbor, MI 48109-1078
Phone (734) 764-1562

Other identifiers 2

IdentifierTypeStateIssuer
195816298OtherMIBCBS OF MI MED SURGICAL
D160120OtherMIBCBS OF MI DENTAL

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050520000651 MI Practitioner - Oral Surgery 9739120627 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2901016012MIMDDentist

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": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213660800000",
    "number": "1598898744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 N UNIVERSITY AVE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481091078",
            "telephone_number": "734-764-1562",
            "fax_number": "734-763-3389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 N UNIVERSITY AVE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481091078",
            "telephone_number": "734-764-1562",
            "fax_number": "734-763-3389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCAULEY",
        "first_name": "LAURIE",
        "middle_name": "K",
        "credential": "DMD PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-14",
        "last_updated": "2008-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901016012",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MI",
            "license": "2901016012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MI MED SURGICAL",
            "identifier": "195816298",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MI DENTAL",
            "identifier": "D160120",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.