Active NPI
Trevor Ingraham
- Physician Assistant
- Novi, MI
National Provider Identifier
1770125577
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 39465 W 14 Mile Rd
Novi, MI 48377-1600 - Phone
- (248) 859-3900
- Fax
- (888) 483-0118
- NPI assigned
- Oct 13, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
39465 W 14 Mile Rd
Novi, MI 48377-1600
Mailing address
39465 W 14 Mile Rd
Novi, MI 48377-1600
Phone (248) 859-3900
Other practice location 1
21844 23 Mile Rd
Macomb, MI 48042-4422
Phone (586) 213-1492
Other practice location 2
22471 Gratiot Ave
Eastpointe, MI 48021-2353
Phone (586) 218-7774
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
39465 W 14 Mile Rd
Novi, MI 48377-1600
Phone (877) 906-9699
Merit-based Incentive Payment System (MIPS)
- Final score
- 57.96 of 100
- Quality
- 21.71
- Promoting interoperability
- 12
- Improvement activities
- 40
- Cost
- 78.16
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 2
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.
-
- Psychiatry Physician
- Novi, MI
- NPI 1154727147
-
- Urgent Care Clinic/Center
- Eastpointe, MI
- NPI 1982125126
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1570924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731888000000",
"number": "1770125577",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "39465 W 14 MILE RD",
"city": "NOVI",
"state": "MI",
"postal_code": "483771600",
"telephone_number": "248-859-3900",
"fax_number": "888-483-0118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "39465 W 14 MILE RD",
"city": "NOVI",
"state": "MI",
"postal_code": "483771600",
"telephone_number": "248-859-3900",
"fax_number": "888-483-0118"
}
],
"practiceLocations": [
{
"address_1": "21844 23 Mile Rd",
"address_purpose": "LOCATION",
"city": "Macomb",
"state": "MI",
"postal_code": "480424422",
"country_code": "US",
"telephone_number": "586-213-1492",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "22471 Gratiot Ave",
"address_purpose": "LOCATION",
"city": "Eastpointe",
"state": "MI",
"postal_code": "480212353",
"country_code": "US",
"telephone_number": "586-218-7774",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "INGRAHAM",
"first_name": "TREVOR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-10-13",
"last_updated": "2024-11-18",
"certification_date": "2024-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Novi, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; 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.