NPIMap

Individual provider Active NPI

Leonard Eugene Ellison Jr., MD

  • Internal Medicine Physician
  • Southfield, MI
National Provider Identifier
1679575328
Registry record updated Aug 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301068024 Issued in MI
Practice address
17330 Northland Park CT
Southfield, MI 48075-4318
Phone
(248) 552-9500
Fax
(248) 552-8144
NPI assigned
Aug 12, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 27, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301068024 MI Primary

Addresses

Primary practice location

17330 Northland Park CT
Southfield, MI 48075-4318

Mailing address

17330 Northland Park CT
Southfield, MI 48075-4318
Phone (248) 552-9500

Other identifiers 2

IdentifierTypeStateIssuer
1679575328MedicaidMI
1106353112OtherMIBCBS

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
I20040227000124 MI Practitioner - Internal Medicine 5395631188 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Wayne State University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Leonard Ellison Jr MD PCGroup PAC ID 2567412893, 2 clinicians
Sciometrix LLCGroup PAC ID 7618367087, 58 clinicians

Practice addresses (Care Compare)

17330 Northland Park CT
Southfield, MI 48075-4318
Phone (248) 552-9500

306 S Washington Ave
Suite 600
Royal Oak, MI 48067-3837
Phone (860) 335-5064

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Gilead Traumatic Brain & Back Rehab LLC CurrentSince Apr 16, 2023 Accepting new patients
Sciometrix LLC CurrentSince Jan 15, 2024 Accepting new patients
Sciometrix Inc CurrentSince Jan 15, 2024 Accepting new patients
Ccla 9 LLC Past Accepting new patients
VHS Harper-Hutzel Hospital Inc Past Accepting new patients
Internal Medicine Specialties PC Internal Medicine Past Accepting new patients
Quality Medical Healthcare Office Management,Inc. Past Accepting new patients
Ccla9, LLC Past Accepting new patients
Outer Drive Partners LLC Past Accepting new patients
TGW Medical Inc Past Accepting new patients
Mission Point of Detroit, LLC Past Accepting new patients
Richey Care Consultants LLC PastSince Oct 1, 2021 Accepting new patients
Colonial Healthcare Center LLC Past Accepting new patients
Vibra of Southeastern Michigan, LLC Past Accepting new patients
Michigan Care Management Solutions LLC PastSince Oct 16, 2022 Accepting new patients
VHS Detroit Receiving Hospital Inc Past Accepting new patients
Metro Man I Inc Past Accepting new patients

Locations

306 S Washington Ave
Ste 600
Royal Oak, MI 48067

17330 Northland Park Ct
Ste 200
Southfield, MI 48075
Phone (248) 233-6467

Interoperability endpoints

  • Direct secure messaging: lellison@direct.dmc.org

Organizations & group practices 20

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.

View all 20

Hospital & facility affiliations 12

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": "1123804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377561600000",
    "number": "1679575328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17330 NORTHLAND PARK CT",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754318",
            "telephone_number": "248-552-9500",
            "fax_number": "248-552-8144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17330 NORTHLAND PARK CT",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754318",
            "telephone_number": "248-552-9500",
            "fax_number": "248-552-8144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "LEONARD",
        "middle_name": "EUGENE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-12",
        "last_updated": "2013-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301068024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679575328",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1106353112",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.