Individual provider Active NPI

Lance Raymond Woody, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Detroit, MI
National Provider Identifier
1699296772
Registry record updated Sep 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
4704273806 Issued in MI
Practice address
22101 Moross Rd
Detroit, MI 48236-2148
Phone
(313) 343-3605
NPI assigned
Jun 29, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 4704273806 MI Primary

Addresses

Primary practice location

22101 Moross Rd
Detroit, MI 48236-2148

Mailing address

22101 Moross Rd
Detroit, MI 48236-2148
Phone (313) 343-3605

Other practice location 1

22622 OConnor St
Saint Clair Shores, MI 48080-4122
Phone (586) 215-7241

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
I20191015003261 MI Practitioner - Nurse Practitioner 4183955511 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Health St. John HospitalGroup PAC ID 3173424082, 332 clinicians

Practice addresses (Care Compare)

22101 Moross Rd
Detroit, MI 48236-2148
Phone (586) 753-0011

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health St. John Hospital CurrentSince Sep 1, 2019 Accepting new patients
Henry Ford Health St. John Hospital CurrentSince Sep 1, 2019 Accepting new patients
Henry Ford Health St. John Hospital Current Accepting new patients
St. John Hospital Past Accepting new patients

Locations

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

22151 Moross Rd
Ste 214
Grosse Pointe, MI 48236
Phone (313) 343-4867

22151 Moross Rd
Grosse Pointe Woods, MI 48236
Phone (313) 343-4867

Interoperability endpoints

  • Direct secure messaging: lwoody1158153@direct.hfhs.org

Organizations & group practices 4

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": "1498694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662076800000",
    "number": "1699296772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22101 MOROSS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362148",
            "telephone_number": "313-343-3605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22101 MOROSS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362148",
            "telephone_number": "313-343-3605"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22622 OConnor St",
            "address_purpose": "LOCATION",
            "city": "Saint Clair Shores",
            "state": "MI",
            "postal_code": "480804122",
            "country_code": "US",
            "telephone_number": "586-215-7241",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOODY",
        "first_name": "LANCE",
        "middle_name": "RAYMOND",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-29",
        "last_updated": "2022-09-02",
        "certification_date": "2022-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MI",
            "license": "4704273806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.