Tia Dominique Agboruche

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

4704311021 Issued in MI

Practice address

20418 Binder St
Detroit, MI 48234-1913

Phone

(313) 333-4038

NPI assigned

Sep 20, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Tia Dominique Sharp Former name

Medicare fee-for-service enrollment

Enrolled in MI, OH2 enrollments

Enrollment records 2

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Henry Ford Health Genesys HospitalGroup PAC ID 2062323033, 85 clinicians

Southwest Ohio Anesthesia Consultants LLCGroup PAC ID 6901700640, 362 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension Genesys Hospital Hospital, Grand Blanc, MI, CCN 230197

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8209/brand/5/csg/21/fhir/r4

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.

• Henry Ford Health Genesys Hospital

  • Certified Registered Nurse Anesthetist
  • Grand Blanc, MI
  • NPI 1558517367

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Southwest Ohio Anesthesia Consultants LLC

  • Anesthesiology Physician
  • Cincinnati, OH
  • NPI 1588645188

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Capital Area Anesthesia PC

  • Pain Medicine (Anesthesiology) Physician
  • Okemos, MI
  • NPI 1538105010

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Northstar Anesthesia of Michigan III PLLC

  • Pain Medicine (Anesthesiology) Physician
  • Irving, TX
  • NPI 1972126209

  MI, Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Ascension Genesys Hospital

  • Skilled Nursing Facility
  • Grand Blanc, MI
  • NPI 1093125312
  NPD
• Southwest Ohio Anesthesia Consultants LLC

  • Anesthesiology Physician
  • Cincinnati, OH
  • NPI 1255768107

  Nurse Anesthetist, Certified Registered

  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Henry Ford Health Genesys Hospital

  • General Acute Care Hospital
  • Grand Blanc, MI
  • NPI 1407877723
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1632096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728259200000",
    "number": "1013687029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20418 BINDER ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482341913",
            "telephone_number": "313-333-4038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20418 BINDER ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482341913",
            "telephone_number": "313-333-4038"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "410 W 10th Ave Fl 1",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432101240",
            "country_code": "US",
            "telephone_number": "614-293-8487",
            "fax_number": "614-293-8153",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AGBORUCHE",
        "first_name": "TIA",
        "middle_name": "DOMINIQUE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-20",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704311021",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "APRN.CRNA.0021121",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704311021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIA",
            "last_name": "SHARP",
            "middle_name": "DOMINIQUE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Anand Agarwal, M.D
• Priti Agarwal, MD
• Barun Agarwalla, MBBS
• Cynthia Chimdimma Agbo, MD
• Kazeem Agboola, DPT
• David Agemy
• Harvey Ager, MD
• Radhika Aggarwal, MD
• Sanjeev Aggarwal, M.D.
• Aggrandize Diagnostic Testing

• Certified Registered Nurse Anesthetist in Detroit, MI
• Providers in Detroit, MI by specialty
• Certified Registered Nurse Anesthetist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.