Individual provider Active NPI

Lindsey Elliott De Guehery, MD

  • Internal Medicine Physician
  • Novi, MI
National Provider Identifier
1720033574
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
28018 Issued in NC
Practice address
41800 W 11 Mile Rd Ste 109
Novi, MI 48375-1818
Phone
(252) 291-5864
Fax
(800) 290-5015
NPI assigned
May 23, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RP1001X 28018 NC
Sleep Medicine (Internal Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RS0012X 28018 NC
Internal Medicine Physician 207R00000X 28018 NC Primary

Addresses

Primary practice location

41800 W 11 Mile Rd Ste 109
Novi, MI 48375-1818

Mailing address

1405 Kenan St NW
Wilson, NC 27893-2345
Phone (252) 315-7954

Other identifiers 7

IdentifierTypeStateIssuer
28279OtherNCBCBS OF NC NUMBER
4851761OtherNCUNITED HEALTHCARE
8928279MedicaidNC
CL2570OtherNCMEDICARE RAILROAD NUMBER
10156220OtherNCVOCATIONAL REHAB NUMBER
22907OtherNCMEDCOST NUMBER
7224358OtherNCAETNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040628000580 NC Practitioner - Pulmonary DiseasePractitioner - Internal Medicine 1759366867 Reassigns benefits to 3 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
24 On Physicians, P.C. Single Specialty CurrentSince Oct 4, 2007 Accepting new patients
County of Wilson CurrentSince Feb 18, 2018 Accepting new patients
24 On Physicians, P.C. Single Specialty CurrentSince Oct 4, 2007 Accepting new patients
Theoria Medical Single Specialty CurrentSince Oct 7, 2024 Accepting new patients
Theoria Medical Internal Medicine Past Accepting new patients

Locations

41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763

2401 Wayne Memorial Dr
Goldsboro, NC 27534
Phone (919) 736-2121

3990 US Highway 64 E
Murphy, NC 28906
Phone (828) 837-5939

430 W Health Center Dr
Nags Head, NC 27959
Phone (252) 441-3116

1801 Glendale Dr SW
Wilson, NC 27893
Phone (252) 237-3141

Organizations & group practices 5

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": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1720033574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 KENAN ST NW",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278932345",
            "telephone_number": "252-315-7954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41800 W 11 MILE RD STE 109",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483751818",
            "telephone_number": "252-291-5864",
            "fax_number": "800-290-5015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE GUEHERY",
        "first_name": "LINDSEY",
        "middle_name": "ELLIOTT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NC",
            "license": "28018",
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "NC",
            "license": "28018",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "28018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC NUMBER",
            "identifier": "28279",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "4851761",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8928279",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD NUMBER",
            "identifier": "CL2570",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VOCATIONAL REHAB NUMBER",
            "identifier": "10156220",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST NUMBER",
            "identifier": "22907",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7224358",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Novi, MI

Sources for this page

Verify at the official NPI Registry.