Ira Mickelson, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

IM043839 Issued in MI

Practice address

1777 Axtell
Suite 102
Troy, MI 48084

Phone

(248) 822-6200

NPI assigned

Oct 3, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Obstetrics/GynecologyAlso: Addiction Medicine

Education

University of Michigan Medical School, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Henry Ford Health Brighton Center for RecoveryGroup PAC ID 2668466996, 15 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Henry Ford Health Brighton Center for Recovery Hospital, Brighton, MI, CCN 230279

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: imickelson1141477@direct.hfhs.org
• Direct secure messaging: imickels@direct.dmc.org

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.

• Henry Ford Health Brighton Center for Recovery

  • Substance Abuse Rehabilitation Facility
  • Brighton, MI
  • NPI 1265527337
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Henry Ford Health Brighton Center for Recovery

  • Substance Abuse Rehabilitation Facility
  • Brighton, MI
  • NPI 1265527337

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542067200000",
    "number": "1760576516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1777 AXTELL",
            "address_2": "SUITE 102",
            "city": "TROY",
            "state": "MI",
            "postal_code": "48084",
            "telephone_number": "248-822-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1777 AXTELL",
            "address_2": "SUITE 102",
            "city": "TROY",
            "state": "MI",
            "postal_code": "48084",
            "telephone_number": "248-822-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKELSON",
        "first_name": "IRA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2018-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "MI",
            "license": "5304001863",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "IM043839",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MICHIGAN",
            "identifier": "160F318220",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michigan Physical Therapy Specialists,PC
• Michigan Physicians Group, PC
• Michigan Rehabilitation Specialists of Fowlerville, LLC (ATI Physical Therapy)
• Michigan Spine Institute, PC
• Michigan Telemed PLLC
• Midwest Community Care Services LLC
• Midwest Community Home Healthcare Services LLC
• George S Miguel, D.O.
• Mounir Mikhaeil, MD
• Elizabeth Mikolajczak

• Obstetrics & Gynecology Physician in Troy, MI
• Providers in Troy, MI by specialty
• Obstetrics & Gynecology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.