DR. ALEXANDRA MARIE MENILLO D.O.
NPI 1770016636
Pediatrics - Pediatric Cardiology in Grand Rapids, MI

Q: What is Alexandra Menillo's NPI number?

The NPI number for Alexandra Menillo is 1770016636. It was assigned to this individual provider in the NPPES registry on April 7, 2017.

Q: What is Alexandra Menillo's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Cardiology, with taxonomy code 2080P0202X.

Q: When was this NPI record last updated?

The NPPES record for Alexandra Menillo was last updated on December 1, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 07, 2017PECOS EnrolledAccepts Medicare Assignment

25 MICHIGAN ST NE STE 4200, GRAND RAPIDS, MI 49503(616) 267-9150 Get Directions Write a Review

NPPES record last updated: December 1, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 1, 2025, May 26, 2022, Dec 15, 2021 (3 updates tracked since 2021).

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About Dr. Alexandra Marie Menillo D.o. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. ALEXANDRA MARIE MENILLO D.O. (NPI 1770016636) is an individual pediatric cardiology provider in Grand Rapids, Michigan, licensed in Michigan (5101026148) and active in the NPI registry since April 2017. She is enrolled in Medicare PECOS, is affiliated with Children's Hospital Of Michigan, and maintains a secondary practice location in Detroit.

NPPES Registry Identity

NPI1770016636

Entity TypeIndividualFemale

Primary Taxonomy2080P0202X

Provider Legal NameDR. ALEXANDRA MARIE MENILLOCredential: D.O.

Location Address25 MICHIGAN ST NE STE 4200Grand Rapids, MI 49503-2559

Mailing Address1 Ford Pl Ste 3aDetroit, MI 48202-3450 · (313) 874-4806 · Fax (313) 876-1305

Phone(616) 267-9150

Sole ProprietorYes

Medical School CMSKansas City University Of Med & Biosciences, College Of Osteo MedGraduated 2017

Enumeration DateApril 7, 2017

Last NPPES UpdateDecember 1, 20253 updates tracked since enumeration

NPPES CertifiedDecember 1, 2025

✔ NPI 1770016636 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatrics · Pediatric CardiologyAllopathic & Osteopathic Physicians

Taxonomy Code2080P0202X

License✔ Licensed in MI · 5101026148

Definition

A pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and evaluating the structural and functional assessment of the heart and blood vessels, and the clinical evaluation of cardiovascular disease.

Also ListedPediatricsTaxonomy 208000000X · License 5101026148 (MI)

25 MICHIGAN ST NE STE 4200, Grand Rapids, MI 49503

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Secondary Practice Location 1

Location 12799 W Grand BlvdDetroit, MI 48202-2689 · Phone (313) 916-2000

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include McLaren Health Plan Community, Priority Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Alexandra Marie Menillo D.o. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6305249905

PECOS Enrollment IDI20211209001615

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Children's Hospital Of Michigan

Childrens · Detroit, MI

OwnershipProprietary

CMS Certification Number233300

Location3901 Beaubien StreetDetroit, MI 48201 · Wayne County

Emergency services

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

STEPHANIE-GRACE ABINOJA RAYMUNDO M.D.

Pediatrics (Pediatric Cardiology)