NPIMap

Individual provider Active NPI

Stephanie Jill Donovan, DPM

  • Podiatrist
  • Plymouth, MI
National Provider Identifier
1992095467
Registry record updated Oct 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
5901002407 Issued in MI
Practice address
990 W Ann Arbor TRL
Suite 200
Plymouth, MI 48170-6204
Phone
(734) 414-0874
Fax
(734) 414-0875
NPI assigned
Apr 18, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 5901002407 MI Primary

Addresses

Primary practice location

990 W Ann Arbor TRL
Suite 200
Plymouth, MI 48170-6204

Mailing address

990 W Ann Arbor TRL
Suite 200
Plymouth, MI 48170-6204
Phone (734) 414-0874

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140527001475 MI Practitioner - Podiatry 3274784707 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iha Health Services CorporationGroup PAC ID 2466351440, 1,149 clinicians

Practice addresses (Care Compare)

990 W Ann Arbor TRL
Suite 200
Plymouth, MI 48170-1686
Phone (734) 414-0874

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue188
Removal of skin lesions1-10
Removal of nail tissue216
Removal or shaving of skin growth53

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Health Services Corporation Current Accepting new patients
Iha Health Services Corporation Podiatrist CurrentSince Oct 1, 2018 Accepting new patients
Iha Health Service Corporation CurrentSince Oct 1, 2018 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

49650 Cherry Hill Rd
Ste 120
Canton, MI 48187
Phone (734) 398-7800

128 Van Buren St
Chelsea, MI 48118
Phone (734) 475-8677

990 W Ann Arbor Trl
Ste 200
Plymouth, MI 48170
Phone (734) 414-0874

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

5333 McAuley Dr
Rm 4012
Ypsilanti, MI 48197
Phone (734) 572-1141

4990 W Clark Rd
Ste 200
Ypsilanti, MI 48197
Phone (734) 572-7500

Interoperability endpoints

  • Direct secure messaging: sdonovan40743@direct.trinity-health.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 11

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": "1303084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412208000000",
    "number": "1992095467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "990 W ANN ARBOR TRL",
            "address_2": "SUITE 200",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481706204",
            "telephone_number": "734-414-0874",
            "fax_number": "734-414-0875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 W ANN ARBOR TRL",
            "address_2": "SUITE 200",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481706204",
            "telephone_number": "734-414-0874",
            "fax_number": "734-414-0875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONOVAN",
        "first_name": "STEPHANIE",
        "middle_name": "JILL",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-18",
        "last_updated": "2014-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MI",
            "license": "5901002407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MI

Sources for this page

Verify at the official NPI Registry.