NPIMap

Individual provider Active NPI

Laurel Gotha, PA

  • Physician Assistant
  • Livonia, MI
National Provider Identifier
1912723826
Registry record updated Oct 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601012980 Issued in MI
Practice address
14555 Levan Rd Ste 311
Suite 311
Livonia, MI 48154
Phone
(734) 655-2692
Fax
(734) 655-4218
NPI assigned
Nov 25, 2024
Last updated
Oct 21, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2025

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 5601012980 MI Primary

Addresses

Primary practice location

14555 Levan Rd Ste 311
Suite 311
Livonia, MI 48154

Mailing address

24 Frank Lloyd Wright Drive
Suite J2000
Ann Arbor, MI 48105
Phone (734) 747-6766

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, MI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250401002598 OH Practitioner - Physician Assistant 4587187471 Reassigns benefits to 2 organizations
I20251020001355 MI Practitioner - Physician Assistant 4587187471 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iha Olma Specialty 1 LLCGroup PAC ID 6901206689, 67 clinicians

Practice addresses (Care Compare)

19000 St Joes Pkwy
Livonia, MI 48152-1477

36475 5 Mile Rd
Livonia, MI 48154-1971
Phone (734) 655-2692

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601012980MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Toledo Hospital CurrentSince Aug 1, 2025 Accepting new patients
Iha Olma Specialty 1 LLC CurrentSince Oct 1, 2025 Accepting new patients
Iha Health Services Corporation CurrentSince Oct 1, 2025 Accepting new patients
Iha Health Services Corporation Current Accepting new patients
The Toledo Hospital CurrentSince Aug 1, 2025 Accepting new patients
Iha Olma Specialty 1 LLC CurrentSince Oct 1, 2025 Accepting new patients
Iha Health Service Corporation CurrentSince Oct 1, 2025 Accepting new patients
Haematology-Oncology Associates of Ohio and Michigan PC Current Accepting new patients
Iha Olma Specialty 1 LLC Current Accepting new patients
Consultants in Laboratory Medicine of Greater Toledo Current Accepting new patients
Iha Health Services Corporation Past Accepting new patients

Locations

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

14555 Levan Rd
Ste 311
Livonia, MI 48154
Phone (248) 858-3850

718 N Macomb St
Monroe, MI 48162
Phone (734) 212-3097

44428 Woodward Ave
Ste 102
Pontiac, MI 48341
Phone (734) 712-8700

2142 N Cove Blvd
Toledo, OH 43606
Phone (419) 291-1111

Interoperability endpoints

  • Direct secure messaging: lgotha4589006@direct.trinity-health.org

Organizations & group practices 13

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.

View all 13

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": "1732492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761004800000",
    "number": "1912723826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 FRANK LLOYD WRIGHT DRIVE",
            "address_2": "SUITE J2000",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48105",
            "telephone_number": "734-747-6766",
            "fax_number": "734-222-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14555 LEVAN RD STE 311",
            "address_2": "SUITE 311",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "48154",
            "telephone_number": "734-655-2692",
            "fax_number": "734-655-4218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOTHA",
        "first_name": "LAUREL",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-25",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601012980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livonia, MI

Sources for this page

Verify at the official NPI Registry.