Active NPI
Angela Marie Clay, D.O.
- Dermatology Physician
- South Lyon, MI
National Provider Identifier
1669609871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 5101018277
- Practice address
- 26036 Pontiac TRL
South Lyon, MI 48178-8050 - Phone
- (248) 479-2200
- Fax
- (248) 479-2682
- NPI assigned
- Jun 15, 2009
- Last updated
- Nov 5, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 5101018277 | MI | Primary |
Addresses
Primary practice location
26036 Pontiac TRL
South Lyon, MI 48178-8050
Mailing address
26036 Pontiac TRL
South Lyon, MI 48178-8050
Phone (248) 479-2200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669609871 | Medicaid | MI |
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: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Dermatology
- Education
- Michigan State University College of Osteopathic Medicine, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
26036 Pontiac TRL
South Lyon, MI 48178-8050
Phone (248) 479-2200
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Promoting interoperability
- 100
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 13 |
| Removal of skin lesions | 413 |
| Removal or shaving of skin growth | 22 |
| Skin biopsy | 104 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101018277 | MI | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Lyon Dermatology, PC | Dermatology | Current | Accepting new patients |
Locations
26036 Pontiac Trl
South Lyon, MI 48178
Phone (248) 479-2200
Interoperability endpoints
- aclay1123438@direct.hfhs.org
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dermatology Physician
- South Lyon, MI
- NPI 1407233323
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Beaumont Hospital-Farmington Hills
- General Acute Care Hospital
- Farmington Hills, MI
- NPI 1336183367
-
dba Internal Medicine Associates Farmington Hills
- Internal Medicine Physician
- Farmington Hills, MI
- NPI 1538103395
Hospital
-
dba Botsford Thoracic Surgery Clinic
- Internal Medicine Physician
- Farmington Hills, MI
- NPI 1912335373
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446681600000",
"number": "1669609871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26036 PONTIAC TRL",
"city": "SOUTH LYON",
"state": "MI",
"postal_code": "481788050",
"telephone_number": "248-479-2200",
"fax_number": "248-479-2682"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26036 PONTIAC TRL",
"city": "SOUTH LYON",
"state": "MI",
"postal_code": "481788050",
"telephone_number": "248-479-2200",
"fax_number": "248-479-2682"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLAY",
"first_name": "ANGELA",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-06-15",
"last_updated": "2015-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "MI",
"license": "5101018277",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1669609871",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Lyon, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2015; 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.