Individual provider Active NPI

Lynette A Mollo, NP

  • Nurse Practitioner
  • Ann Arbor, MI
National Provider Identifier
1992925606
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704164297 Issued in MI
Practice address
24 Frank Lloyd Wright Dr
Ann Arbor, MI 48109
Phone
(734) 998-7400
NPI assigned
Apr 26, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 4704164297 MI Primary

Addresses

Primary practice location

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48109

Mailing address

3621 S State St
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

Other identifiers 1

IdentifierTypeStateIssuer
4290419MedicaidMI

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
I20110302000428 MI Practitioner - Nurse Practitioner 4880875442 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Regents of the University of MichiganGroup PAC ID 3779496856, 3,344 clinicians

Practice addresses (Care Compare)

1500 E Medical Ctr Dr
Ann Arbor, MI 48109-5000
Phone (734) 936-4000

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105-9484
Phone (734) 647-5640

Hospital & facility affiliations

  • University of Michigan Health System Hospital, Ann Arbor, MI, CCN 230046

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Michigan CurrentSince Mar 1, 2000 Accepting new patients
Regents of the University of Michigan Nurse Practitioner CurrentSince Mar 1, 2000 Accepting new patients
Regents of the University of Michigan Past Accepting new patients

Locations

1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280

3621 S State St
#700
Ann Arbor, MI 48108

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

Organizations & group practices 3

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 1

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": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992925606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 FRANK LLOYD WRIGHT DR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48109",
            "telephone_number": "734-998-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLLO",
        "first_name": "LYNETTE",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704164297",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4290419",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.