NPIMap

Individual provider Active NPI

Anthony Delise III, MD

  • Family Medicine Physician
  • Roseville, MI
National Provider Identifier
1639752165
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301509897 Issued in MI
Practice address
30695 Little Mack Ave Ste 200
Roseville, MI 48066-1781
Phone
(586) 294-9600
NPI assigned
May 3, 2021
Last updated
Jun 20, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

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 4301509897 MI Primary

Addresses

Primary practice location

30695 Little Mack Ave Ste 200
Roseville, MI 48066-1781

Mailing address

30695 Little Mack Ave Ste 200
Roseville, MI 48066-1781
Phone (586) 294-9600

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address adelise497476@direct.beaumont.edu

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
I20240104000902 MI Practitioner - Family Practice 8123437977 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Oakland Univ, William Beaumont School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Oakwood Ambulatory LLCGroup PAC ID 1850282914, 271 clinicians

Practice addresses (Care Compare)

201 3Rd St
Suite 200
Belleville, MI 48111-2605
Phone (734) 697-9065

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Oakwood Ambulatory LLC Single Specialty CurrentSince Nov 15, 2023 Accepting new patients
Oakwood Ambulatory, LLC Single Specialty CurrentSince Nov 15, 2023 Accepting new patients
William Beaumont Hospital Single Specialty Past Accepting new patients

Locations

201 3rd St
Ste 200
Belleville, MI 48111
Phone (734) 697-9065

468 Cadieux Rd
Grosse Pointe Woods, MI 48230
Phone (313) 343-1000

30695 Little Mack Ave
Ste 200
Roseville, MI 48066
Phone (586) 294-9600

21400 E 11 Mile Rd
St Clr Shores, MI 48081
Phone (586) 498-4400

Interoperability endpoints

  • Direct secure messaging: adelise1230963@epic00.shdirect.org
  • Direct secure messaging: adelise497476@direct.beaumont.edu

Organizations & group practices 3

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1639752165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30695 LITTLE MACK AVE STE 200",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480661781",
            "telephone_number": "586-294-9600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30695 LITTLE MACK AVE STE 200",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480661781",
            "telephone_number": "586-294-9600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELISE",
        "first_name": "ANTHONY",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-05-03",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301509897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "adelise497476@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "21400 E 11 Mile Rd",
            "city": "Saint Clair Shores",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480811566",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Roseville, MI

Sources for this page

Verify at the official NPI Registry.