Individual provider Active NPI

Danielle Wilseck, PA-C

  • Physician Assistant
  • Ypsilanti, MI
National Provider Identifier
1669896759
Registry record updated Feb 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601006941 Issued in MI
Practice address
5361 McAuley Dr
Ypsilanti, MI 48197-1011
Phone
(734) 712-1300
Fax
(734) 222-3665
NPI assigned
Feb 10, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601006941 MI Primary

Addresses

Primary practice location

5361 McAuley Dr
Ypsilanti, MI 48197-1011

Mailing address

24 Frank Lloyd Wright Dr
PO Box 0446 Lobby J
Ann Arbor, MI 48105-9484
Phone (734) 747-6766

Other names 1

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140303001231 MI Practitioner - Physician Assistant 2769612290 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iha Health Services CorporationGroup PAC ID 2466351440, 1,149 clinicians

Practice addresses (Care Compare)

44428 Woodward Ave
Suite 102
Pontiac, MI 48341-5009
Phone (734) 712-8700

51341 W Huron River Dr
Trinity Health Iha Medical Group Primary Ca
Van Buren Township, MI 48111-2571
Phone (734) 997-0304

5361 McAuley Dr
Ypsilanti, MI 48197-1011
Phone (734) 712-1300

5401 McAuley Dr
Ypsilanti, MI 48197-1011
Phone (734) 786-2300

Hospital & facility affiliations

  • Trinity Health Ann Arbor Hospital Hospital, Ann Arbor, MI, CCN 230156
  • Chelsea Hospital Hospital, Chelsea, MI, CCN 230259

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Health Service Corporation CurrentSince Jul 1, 2016 Accepting new patients
Advantage Health Saint Mary'S Medical Group Physician Assistant CurrentSince Feb 7, 2014 Accepting new patients
Advantage Health/Saint Mary'S Medical Group CurrentSince Feb 7, 2014 Accepting new patients
Iha Health Services Corporation CurrentSince Jul 1, 2016 Accepting new patients

Locations

3200 W Liberty Rd
Ste C
Ann Arbor, MI 48103
Phone (734) 761-2581

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

2305 Genoa Business Park Dr
Ste 200
Brighton, MI 48114
Phone (810) 494-6840

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

49650 Cherry Hill Rd
Ste 120
Canton, MI 48187
Phone (734) 398-7800

128 Van Buren St
Chelsea, MI 48118
Phone (734) 475-8677

1255 E M 36
Pinckney, MI 48169
Phone (734) 878-1000

44428 Woodward Ave
Ste 102
Pontiac, MI 48341
Phone (734) 712-8700

4990 W Clark Rd
Ste 200
Ypsilanti, MI 48197
Phone (734) 572-7500

4940 W Clark Rd
Ste 100
Ypsilanti, MI 48197
Phone (734) 434-0477

5361 McAuley Dr
Ypsilanti, MI 48197
Phone (734) 712-1300

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.

Hospital & facility affiliations 2

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": "1391990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519603200000",
    "number": "1669896759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 FRANK LLOYD WRIGHT DR",
            "address_2": "PO BOX 0446 LOBBY J",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481059484",
            "telephone_number": "734-747-6766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5361 MCAULEY DR",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971011",
            "telephone_number": "734-712-1300",
            "fax_number": "734-222-3665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSECK",
        "first_name": "DANIELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-10",
        "last_updated": "2018-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601006941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DANIELLE",
            "last_name": "BOLOVEN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Ypsilanti, MI

Sources for this page

Verify at the official NPI Registry.