Individual provider Active NPI

Annette L Wahl, NP

  • Nurse Practitioner
  • Southfield, MI
National Provider Identifier
1861437410
Registry record updated Jan 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704154666 Issued in MI
Practice address
24111 Southfield Rd
Southfield, MI 48075-2817
Phone
(248) 557-8800
Fax
(248) 557-8860
NPI assigned
Jun 18, 2006
Last updated
Jan 22, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704154666 MI Primary

Addresses

Primary practice location

24111 Southfield Rd
Southfield, MI 48075-2817

Mailing address

24111 Southfield Rd
Southfield, MI 48075-2817
Phone (248) 557-8800

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address awahl4858@direct.beaumont.edu

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
I20031210000202 MI Practitioner - Nurse Practitioner 3971409095 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

28100 Grand River Ave
Farmington Hills, MI 48336-5970

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712

3601 W 13 Mile Rd Ec
Beaumont Emergency Services Ro
Royal Oak, MI 48073-6712
Phone (248) 898-5058

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.37 of 100Reported as group
Quality
66.73
Promoting interoperability
100
Improvement activities
40
Cost
70.98

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Beaumont Medical Group Hospital -Based Services CurrentSince Jul 14, 2018 Accepting new patients
Beaumont Medical Group- Specialty Services CurrentSince Jun 26, 2021 Accepting new patients
Annette Wahl, MD, PC PastSince Dec 15, 2003 Accepting new patients
Vpa PC Past Accepting new patients

Locations

28100 Grand River Ave
Ste 301
Farmington Hills, MI 48336
Phone (947) 521-1320

468 Cadieux Rd
Grosse Pointe Woods, MI 48230
Phone (313) 343-1000

3601 W 13 Mile Rd
Royal Oak, MI 48073

44201 Dequindre Rd
Troy, MI 48085
Phone (248) 471-8255

Interoperability endpoints

  • Direct secure messaging: awahl1455287@epic00.shdirect.org

Organizations & group practices 4

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 3

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": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611273600000",
    "number": "1861437410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24111 SOUTHFIELD RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752817",
            "telephone_number": "248-557-8800",
            "fax_number": "248-557-8860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24111 SOUTHFIELD RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752817",
            "telephone_number": "248-557-8800",
            "fax_number": "248-557-8860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAHL",
        "first_name": "ANNETTE",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-18",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704154666",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "awahl4858@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "24111 Southfield Rd",
            "city": "Southfield",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480752817",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.