Individual provider Active NPI

Erica Michelle Fovenesi, PA

  • Physician Assistant
  • Flint, MI
National Provider Identifier
1841692373
Registry record updated Jan 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601007093 Issued in MI
Practice address
4466 W Bristol Rd
Flint, MI 48507-3170
Phone
(810) 733-1200
Fax
(810) 733-0688
NPI assigned
Sep 16, 2014
Last updated
Jan 7, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 5601007093 MI Primary

Addresses

Primary practice location

4466 W Bristol Rd
Flint, MI 48507-3170

Mailing address

4466 W Bristol Rd
Flint, MI 48507-3170
Phone (810) 733-1200

Other identifiers 2

IdentifierTypeStateIssuer
5250505OtherMIBCBSM
1841692373MedicaidMI

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
I20150312000374 MI Practitioner - Physician Assistant 6305068719 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Eastern Virginia Medical School, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 916-2600

6777 W Maple Rd
Henry Ford West Bloomfield Med Ctr
West Bloomfield, MI 48322-3013
Phone (248) 661-4100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601007093MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Macomb Hospital Corporation CurrentSince Dec 29, 2019 Accepting new patients
Henry Ford Macomb Hospital Corporation CurrentSince Dec 29, 2019 Accepting new patients
Henry Ford Wyandotte Hospital CurrentSince May 1, 2020 Accepting new patients
Henry Ford Wyandotte Hospital CurrentSince May 1, 2020 Accepting new patients
W.a. Foote Memorial Hospital, Inc Physician Assistant CurrentSince Dec 29, 2019 Accepting new patients
W.a. Foote Memorial Hospital, Inc CurrentSince Dec 29, 2019 Accepting new patients
Henry Ford Health System Physician Assistant CurrentSince Jun 15, 2015 Accepting new patients
Henry Ford Health System CurrentSince Jun 15, 2015 Accepting new patients

Locations

15717 15 Mile Rd
Clinton Twp, MI 48035
Phone (586) 285-3800

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

2799 W Grand Blvd
#K11
Detroit, MI 48202
Phone (313) 916-2241

813 W Michigan Ave
Jackson, MI 49202
Phone (517) 205-1000

7845 Spring Arbor Rd
Spring Arbor, MI 49283
Phone (517) 205-2580

6777 W Maple Rd
West Bloomfield, MI 48322
Phone (248) 325-1000

2070 Biddle Ave
Ste 2
Wyandotte, MI 48192
Phone (734) 284-7482

Interoperability endpoints

  • Direct secure messaging: efovenesi363200@direct.hfhs.org

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1410825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641513600000",
    "number": "1841692373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4466 W BRISTOL RD",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485073170",
            "telephone_number": "810-733-1200",
            "fax_number": "810-733-0688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4466 W BRISTOL RD",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485073170",
            "telephone_number": "810-733-1200",
            "fax_number": "810-733-0688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOVENESI",
        "first_name": "ERICA",
        "middle_name": "MICHELLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-16",
        "last_updated": "2022-01-07",
        "certification_date": "2022-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007093",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "5250505",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1841692373",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flint, MI

Sources for this page

Verify at the official NPI Registry.