Individual provider Active NPI

Nicole Brooke Langan, PA-C

  • Physician Assistant
  • Detroit, MI
National Provider Identifier
1821980608
Registry record updated Jul 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601013045 Issued in MI
Practice address
259 Mack Ave Ste 2590
Detroit, MI 48201-2427
Phone
(313) 577-1716
NPI assigned
Jul 16, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X MI
Physician Assistant 363A00000X 5601013045 MI Primary

Addresses

Primary practice location

259 Mack Ave Ste 2590
Detroit, MI 48201-2427

Mailing address

7114 Woodlore CT
West Bloomfield, MI 48323-4029
Phone (248) 252-3062

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
I20260328000263 MI Practitioner - Physician Assistant 3870089212 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Restorative Physical Medicine PLLCGroup PAC ID 0042631194, 20 clinicians

Practice addresses (Care Compare)

42350 Grand River Ave
Novi, MI 48375-1838
Phone (248) 697-2942

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601013045MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Restorative Physical Medicine PLLC CurrentSince Feb 22, 2026 Accepting new patients

Locations

42350 Grand River Ave
Novi, MI 48375
Phone (248) 697-2942

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HCJACD

Organizations & group practices 1

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": "1752624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752624000000",
    "number": "1821980608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7114 WOODLORE CT",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483234029",
            "telephone_number": "248-252-3062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "259 MACK AVE STE 2590",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012427",
            "telephone_number": "313-577-1716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANGAN",
        "first_name": "NICOLE",
        "middle_name": "BROOKE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-16",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601013045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.