Individual provider Active NPI

Nicole Salloum

  • Physician Assistant
  • Livonia, MI
National Provider Identifier
1861013120
Registry record updated Apr 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
36167 Meadowbrook St
Livonia, MI 48154-5128
Phone
(734) 751-8427
NPI assigned
Apr 28, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2020

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

36167 Meadowbrook St
Livonia, MI 48154-5128

Mailing address

36167 Meadowbrook St
Livonia, MI 48154-5128
Phone (734) 751-8427

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
I20210430001721 MI Practitioner - Physician Assistant 4284043399 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

168 S Howell St
Hillsdale, MI 49242-2040
Phone (517) 437-4451

168 S Howell St
Hillsdale, MI 49242-2081

451 Hidden Meadows Dr
Hillsdale, MI 49242-9812

61 W Carleton Rd
Hillsdale, MI 49242-1201
Phone (517) 439-5411

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Hillsdale Community Health Center CurrentSince May 1, 2021 Accepting new patients
Hillsdale Community Health Center CurrentSince May 1, 2021 Accepting new patients

Locations

168 S Howell St
Hillsdale, MI 49242
Phone (517) 437-4451

168 S Howell St
Fl 3
Hillsdale, MI 49242

61 W Carleton Rd
Hillsdale, MI 49242
Phone (517) 437-5020

Interoperability endpoints

  • Direct secure messaging: nsalloum461960@direct.parkviewexchange.com

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.

Hospital & facility affiliations 1

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": "1588032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588032000000",
    "number": "1861013120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36167 MEADOWBROOK ST",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481545128",
            "telephone_number": "734-751-8427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36167 MEADOWBROOK ST",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481545128",
            "telephone_number": "734-751-8427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALLOUM",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-28",
        "last_updated": "2020-04-28",
        "certification_date": "2020-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livonia, MI

Sources for this page

Verify at the official NPI Registry.