Individual provider Active NPI

Karen Suzanne Deloss, O.D.

  • Optometrist
  • Ann Arbor, MI
National Provider Identifier
1750533352
Registry record updated Jun 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901004562 Issued in MI
Practice address
1000 Wall Street
Ann Arbor, MI 48105-1912
Phone
(734) 764-4190
NPI assigned
Oct 15, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 7302T TX
Optometrist 152W00000X 4901004562 MI Primary

Addresses

Primary practice location

1000 Wall Street
Ann Arbor, MI 48105-1912

Mailing address

3621 S State St
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101029000790 MI Practitioner - Optometry 1355403221 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Regents of the University of MichiganGroup PAC ID 3779496856, 3,344 clinicians

Practice addresses (Care Compare)

1000 Wall St
Ann Arbor, MI 48105-1912
Phone (734) 764-4190

7500 Challis Rd
Brighton, MI 48116-9416
Phone (734) 764-4190

Hospital & facility affiliations

  • University of Michigan Health System Hospital, Ann Arbor, MI, CCN 230046

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7302TTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Michigan Optometrist CurrentSince Jun 30, 2010 Accepting new patients
Regents of the University of Michigan CurrentSince Jun 30, 2010 Accepting new patients
Regents of the University of Michigan Past Accepting new patients
Regents of the University of Michigan Past Accepting new patients
Regents of the University of Michigan Past Accepting new patients
Regents of the University of Michigan Past Accepting new patients

Locations

380 Parkland Plz
Ann Arbor, MI 48103
Phone (734) 615-3217

380 Parkland Plz
Ste 210
Ann Arbor, MI 48103

1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280

3621 S State St
#700
Ann Arbor, MI 48108

1000 Wall St
Ann Arbor, MI 48105
Phone (734) 763-1415

7500 Challis Rd
Brighton, MI 48116
Phone (734) 764-4190

39901 Traditions Dr
Ste 230
Northville, MI 48168
Phone (248) 305-4400

Interoperability endpoints

  • Direct secure messaging: kdeloss26520@direct.med.umich.edu

Organizations & group practices 6

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.

Hospital & facility affiliations 1

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": "1224028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277164800000",
    "number": "1750533352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 WALL STREET",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481051912",
            "telephone_number": "734-764-4190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELOSS",
        "first_name": "KAREN",
        "middle_name": "SUZANNE",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-15",
        "last_updated": "2010-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "7302T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.