Pallav Deka, PHD, AGACNP-BC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704350380 Issued in MI

Practice address

5091 Willoughby Rd
Holt, MI 48842-1054

Phone

(517) 694-2144

Fax

(517) 694-7469

NPI assigned

Apr 18, 2017

Last updated

Aug 23, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vituity - Michigan Hospitalists PCGroup PAC ID 2365860996, 76 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Edward W Sparrow Hospital Hospital, Lansing, MI, CCN 230230

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Vituity - Michigan Hospitalists PC

  • Hospitalist Physician
  • Lansing, MI
  • NPI 1487278156
  Medicare reassignment Care Compare group NPD
• Capital Cardiology PC

  • Specialist
  • Lansing, MI
  • NPI 1710183660
  Medicare reassignment

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

• Edward W Sparrow Hospital Association

  dba University of Michigan Health-Sparrow Lansing

  • General Acute Care Hospital
  • Lansing, MI
  • NPI 1073588711
  Care Compare affiliation
• Edward W Sparrow Hospital Association

  dba Thoracic Cardiovascular Institute

  • General Acute Care Hospital
  • Lansing, MI
  • NPI 1760710719
  Care Compare affiliation

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

{
    "created_epoch": "1492473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724371200000",
    "number": "1861926636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 SERVICE RD STE A109B",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247015",
            "telephone_number": "517-694-2144",
            "fax_number": "517-694-7469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5091 WILLOUGHBY RD",
            "city": "HOLT",
            "state": "MI",
            "postal_code": "488421054",
            "telephone_number": "517-694-2144",
            "fax_number": "517-694-7469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEKA",
        "first_name": "PALLAV",
        "credential": "PHD, AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-18",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704350380",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MI",
            "license": "4704350380",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Holt, MI
• Providers in Holt, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.