NPIMap

Individual provider Active NPI

Nicole Le Rothenberg, MD

  • Family Medicine Physician
  • Novi, MI
National Provider Identifier
1609093491
Registry record updated May 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301088470 Issued in MI
Practice address
26850 Providence Pkwy
Suite 370
Novi, MI 48374-1213
Phone
(248) 465-4160
Fax
(248) 465-4525
NPI assigned
Apr 20, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301088470 MI Primary

Addresses

Primary practice location

26850 Providence Pkwy
Suite 370
Novi, MI 48374-1213

Mailing address

26850 Providence Pkwy
Suite 370
Novi, MI 48374-1213
Phone (248) 465-4160

Other identifiers 1

IdentifierTypeStateIssuer
4301088470OtherMISTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091106000035 MI Practitioner - Family Practice 3173661469 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Premier Therapy Centers, IncGroup PAC ID 5092605717, 140 clinicians

Practice addresses (Care Compare)

29275 Northwestern Hwy
Suite 202
Southfield, MI 48034-5744
Phone (248) 996-8332

33010 Northwestern Hwy
West Bloomfield, MI 48322-3634

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301088470MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Olma Primary Non Risk LLC Family Medicine CurrentSince Dec 1, 2020 Accepting new patients
Iha Olma Primary Non Risk LLC Family Medicine CurrentSince Dec 1, 2020 Accepting new patients
Nicole Rothenberg MD PLLC Family Medicine CurrentSince Dec 30, 2024 Accepting new patients

Locations

20206 Farmington Rd
#M
Livonia, MI 48152
Phone (248) 476-4724

20206 Farmington Rd
Livonia, MI 48152
Phone (248) 471-6585

37595 7 Mile Rd
Ste 210
Livonia, MI 48152
Phone (734) 432-7282

29275 Northwestern Hwy
Ste 202
Southfield, MI 48034
Phone (248) 727-1990

Interoperability endpoints

  • Direct secure messaging: nicole.rothenberg.1@17748.direct.athenahealth.com

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400630400000",
    "number": "1609093491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26850 PROVIDENCE PKWY",
            "address_2": "SUITE 370",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483741213",
            "telephone_number": "248-465-4160",
            "fax_number": "248-465-5425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26850 PROVIDENCE PKWY",
            "address_2": "SUITE 370",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483741213",
            "telephone_number": "248-465-4160",
            "fax_number": "248-465-4525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTHENBERG",
        "first_name": "NICOLE",
        "middle_name": "LE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-20",
        "last_updated": "2014-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301088470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "4301088470",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Novi, MI

Sources for this page

Verify at the official NPI Registry.