Individual provider Active NPI

Trevor Ingraham

  • Physician Assistant
  • Novi, MI
National Provider Identifier
1770125577
Registry record updated Nov 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
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

Updated by the provider on Nov 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210322001864 MI Practitioner - Physician Assistant 8820405780 Reassigns benefits to 2 organizations

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
Behavioral Care Solutions for Adults and Seniors IncGroup PAC ID 4880918051, 71 clinicians

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 100Reported as group
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.

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

Verify at the official NPI Registry.