Individual provider Active NPI

Michael Patrick Klayum, PA-C

  • Physician Assistant
  • Clinton Township, MI
National Provider Identifier
1790101095
Registry record updated Oct 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601007335 Issued in MI
Practice address
15420 19 Mile Rd
Clinton Township, MI 48038-6339
Phone
(586) 226-7007
Fax
(586) 226-7033
NPI assigned
Mar 11, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2016

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 5601007335 MI Primary

Addresses

Primary practice location

15420 19 Mile Rd
Clinton Township, MI 48038-6339

Mailing address

15420 19 Mile Rd
Clinton Township, MI 48038-6339
Phone (586) 226-7007

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
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
I20190830001310 NE Practitioner - Physician Assistant 4082837877 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alegent Creighton ClinicGroup PAC ID 1951210418, 951 clinicians

Practice addresses (Care Compare)

16909 Lakeside Hills CT
Omaha, NE 68130-4661

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2394NEMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Alegent Creighton Clinic CurrentSince Jul 1, 2021 Accepting new patients
Alegent Creighton Clinic CurrentSince Jul 1, 2021 Accepting new patients
Alegent Creighton Clinic Physician Assistant Past Accepting new patients

Locations

2771 Solution Ctr
Chicago, IL 60677

4055 Yankee Hill Rd
Lincoln, NE 68516
Phone (402) 328-6300

16909 Lakeside Hills Ct
Ste 401
Omaha, NE 68130
Phone (402) 827-4920

Organizations & group practices 3

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": "1394496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477612800000",
    "number": "1790101095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15420 19 MILE RD",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480386339",
            "telephone_number": "586-226-7007",
            "fax_number": "586-226-7033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15420 19 MILE RD",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480386339",
            "telephone_number": "586-226-7007",
            "fax_number": "586-226-7033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLAYUM",
        "first_name": "MICHAEL",
        "middle_name": "PATRICK",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-11",
        "last_updated": "2016-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton Township, MI

Sources for this page

Verify at the official NPI Registry.