Individual provider Active NPI

Mikalah Carol Jane O'Neill, C.N.M,

  • Advanced Practice Midwife
  • Detroit, MI
National Provider Identifier
1639317910
Registry record updated Mar 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
4704196544 Issued in MI
Practice address
4201 Saint Antoine St
Suite 4C
Detroit, MI 48201-2153
Phone
(313) 745-4525
Fax
(313) 745-4399
NPI assigned
Jan 26, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X 4704196544 MI Primary

Addresses

Primary practice location

4201 Saint Antoine St
Suite 4C
Detroit, MI 48201-2153

Mailing address

1560 E Maple Rd
Suite 400-Credentialing Department
Troy, MI 48083-1138
Phone (313) 745-4525

Other names 1

  • Carol Jane O'Neill Former name

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090311000068 MI Practitioner - Certified Nurse Midwife (CNM) 5890851208 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
4704196544MIMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health System Current Accepting new patients
Henr Y Ford Health System Advanced Practice Midwife CurrentSince Sep 10, 2018 Accepting new patients
Henry Ford Health System CurrentSince Sep 10, 2018 Accepting new patients
Henry Ford Maplegrove Center Past Accepting new patients
Henry Ford Health System Past Accepting new patients

Locations

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

6777 W Maple Rd
West Bloomfield, MI 48322
Phone (248) 325-1000

Interoperability endpoints

  • Direct secure messaging: omikalah312122@direct.hfhs.org

Organizations & group practices 6

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": "1232928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426809600000",
    "number": "1639317910",
    "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": "313-745-4525",
            "fax_number": "313-745-4399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 SAINT ANTOINE ST",
            "address_2": "SUITE 4C",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012153",
            "telephone_number": "313-745-4525",
            "fax_number": "313-745-4399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'NEILL",
        "first_name": "MIKALAH",
        "middle_name": "CAROL JANE",
        "credential": "C.N.M,",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-26",
        "last_updated": "2015-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "MI",
            "license": "4704196544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROL",
            "last_name": "O'NEILL",
            "middle_name": "JANE",
            "credential": "CNM.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.