Individual provider Active NPI

Pasquale B. Iaderosa, MD

  • Internal Medicine Physician
  • Mount Clemens, MI
National Provider Identifier
1962409094
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301046401 Issued in MI
Practice address
133 S Main St
Suite D
Mount Clemens, MI 48043-2308
Phone
(586) 468-1600
Fax
(586) 465-0329
NPI assigned
Jul 5, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301046401 MI Primary

Addresses

Primary practice location

133 S Main St
Suite D
Mount Clemens, MI 48043-2308

Mailing address

133 S Main St
Mount Clemens, MI 48043-2308
Phone (586) 468-1600

Other identifiers 1

IdentifierTypeStateIssuer
1836979MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address piaderosa240459@direct.hfhs.org

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100708000561 MI Practitioner - Internal Medicine 4284600826 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Wayne State University School of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Physician PartnersGroup PAC ID 8921482605, 79 clinicians

Practice addresses (Care Compare)

133 S Main St
Mount Clemens, MI 48043-2308
Phone (586) 468-1600

Hospital & facility affiliations

  • Henry Ford Macomb Hospital Hospital, Clinton Township, MI, CCN 230047
  • Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301046401MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Health Professionals, PLLC Internal Medicine CurrentSince Jan 1, 2015 Accepting new patients
Henry Ford Physician Partners Internal Medicine CurrentSince Sep 1, 2022 Accepting new patients
Henry Ford Macomb Ancillary Services Current Accepting new patients
Henry Ford Physician Partners CurrentSince Sep 1, 2022 Accepting new patients

Locations

2689 Solution Ctr
Chicago, IL 60677

30795 23 Mile Rd
Ste 201
Chesterfield, MI 48047
Phone (586) 421-1600

30795 23 Mile Rd
Ste 207
Chesterfield, MI 48047
Phone (586) 263-7200

133 S Main St
Ste D
Mount Clemens, MI 48043
Phone (313) 465-1326

133 S Main St
Mount Clemens, MI 48043
Phone (586) 329-1880

Interoperability endpoints

  • Direct secure messaging: piaderosa240459@direct.hfhs.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 and National Provider Directory roles.

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": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608595200000",
    "number": "1962409094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 S MAIN ST",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432308",
            "telephone_number": "586-468-1600",
            "fax_number": "586-465-0329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 S MAIN ST",
            "address_2": "SUITE D",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432308",
            "telephone_number": "586-468-1600",
            "fax_number": "586-465-0329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IADEROSA",
        "first_name": "PASQUALE",
        "middle_name": "B.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-05",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301046401",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1836979",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "piaderosa240459@direct.hfhs.org",
            "affiliation": "N",
            "address_1": "133 S Main St",
            "address_2": "Suite D",
            "city": "Mount Clemens",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480432308",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mount Clemens, MI

Sources for this page

Verify at the official NPI Registry.