Individual provider Active NPI

Allyssa Boddy, NP-C

  • Family Nurse Practitioner
  • Westland, MI
National Provider Identifier
1720562010
Registry record updated Aug 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704292285 Issued in MI
Practice address
35700 Warren Rd Ste C
Westland, MI 48185-3808
Phone
(313) 437-8427
Fax
(313) 437-8429
NPI assigned
Sep 21, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 7, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0200X 4704292285 MI
Family Nurse Practitioner 363LF0000X 4704292285 MI Primary

Addresses

Primary practice location

35700 Warren Rd Ste C
Westland, MI 48185-3808

Mailing address

9029 Pardee Rd
Taylor, MI 48180-2755
Phone (313) 437-8427

Other practice location 1

9029 Pardee Rd
Taylor, MI 48180-2755
Phone (313) 437-8427

Other identifiers 1

IdentifierTypeStateIssuer
4704292285NSA180VYMedicaidMI

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
I20200806000816 MI Practitioner - Nurse Practitioner 8426473588 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Minuteclinic Diagnostic of Michigan PCGroup PAC ID 9133123755, 40 clinicians

Practice addresses (Care Compare)

17120 Kercheval Ave
Grosse Pointe, MI 48230-1661
Phone (866) 389-2727

Merit-based Incentive Payment System (MIPS)

Final score
81.3 of 100Reported as group
Quality
76.96
Improvement activities
40
Cost
79.9

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4704292285MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Minuteclinic Primary Care-Michigan PLLC Family CurrentSince Sep 12, 2025 Accepting new patients
Minuteclinic Diagnostic of Michigan PC Family CurrentSince Jul 17, 2020 Accepting new patients
Michigan Heart and Vascular Past Accepting new patients

Locations

17120 Kercheval Ave
Grosse Pointe, MI 48230
Phone (313) 886-3300

44300 5 Mile Rd
Northville, MI 48168
Phone (734) 416-1883

39350 9 Mile Rd
Northville Township, MI 48167
Phone (248) 735-6081

100 W West Maple Rd
Walled Lake, MI 48390
Phone (248) 624-4555

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359

Organizations & group practices 3

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": "1537488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786060800000",
    "number": "1720562010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9029 PARDEE RD",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481802755",
            "telephone_number": "313-437-8427",
            "fax_number": "313-447-8429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35700 WARREN RD STE C",
            "city": "WESTLAND",
            "state": "MI",
            "postal_code": "481853808",
            "telephone_number": "313-437-8427",
            "fax_number": "313-437-8429"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9029 Pardee Rd",
            "address_purpose": "LOCATION",
            "city": "Taylor",
            "state": "MI",
            "postal_code": "481802755",
            "country_code": "US",
            "telephone_number": "313-437-8427",
            "fax_number": "313-437-8429",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BODDY",
        "first_name": "ALLYSSA",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-21",
        "last_updated": "2026-08-07",
        "certification_date": "2026-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "MI",
            "license": "4704292285",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704292285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4704292285NSA180VY",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Westland, MI

Sources for this page

Verify at the official NPI Registry.