Individual provider Active NPI

Agnes Beata Pilecki, AGNP-C

  • Gerontology Nurse Practitioner
  • Detroit, MI
National Provider Identifier
1740968262
Registry record updated Jul 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
4704330800 Issued in MI
Practice address
4100 John R St
Detroit, MI 48201-2013
Phone
(800) 527-6266
NPI assigned
Jul 5, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 9630327 FL
Gerontology Nurse Practitioner 363LG0600X 4704330800 MI Primary

Addresses

Primary practice location

4100 John R St
Detroit, MI 48201-2013

Mailing address

4100 John R St
Detroit, MI 48201-2013
Phone (800) 527-6266

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
I20230823001287 MI Practitioner - Nurse Practitioner 3678936739 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Physician GroupGroup PAC ID 8628087681, 399 clinicians

Practice addresses (Care Compare)

4100 John R St
Detroit, MI 48201-2013
Phone (800) 527-6266

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9630327FLMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Barbara Ann Karmanos Cancer Institute CurrentSince Aug 7, 2023 Accepting new patients
University Physician Group CurrentSince Oct 27, 2023 Accepting new patients
Barbara Ann Karmanos Cancer Institute CurrentSince Aug 7, 2023 Accepting new patients
University Physician Group Past Accepting new patients
Barbara Ann Karmanos Cancer Institute Past Accepting new patients

Locations

4100 John R St
Detroit, MI 48201
Phone (313) 576-8530

4100 John R St
Bldg 1026
Detroit, MI 48201

31995 Northwestern Hwy
Farmington Hills, MI 48334
Phone (248) 538-4701

1560 E Maple Rd
Ste 200
Troy, MI 48083
Phone (248) 581-5200

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": "1688515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1740968262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 JOHN R ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012013",
            "telephone_number": "800-527-6266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 JOHN R ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012013",
            "telephone_number": "800-527-6266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PILECKI",
        "first_name": "AGNES",
        "middle_name": "BEATA",
        "credential": "AGNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-05",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "9630327",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MI",
            "license": "4704330800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.