NPIMap

Individual provider Active NPI

Leonid Mironovich Shamban, D.O.

  • Gastroenterology Physician
  • Saint Clair Shores, MI
National Provider Identifier
1225398431
Registry record updated Sep 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
5101019763 Issued in MI
Practice address
28963 Little Mack Ave Ste 101
Saint Clair Shores, MI 48081-3017
Phone
(586) 447-0700
Fax
(586) 498-0707
NPI assigned
May 22, 2012
Last updated
Sep 22, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 5101019763 MI Primary

Addresses

Primary practice location

28963 Little Mack Ave Ste 101
Saint Clair Shores, MI 48081-3017

Mailing address

28963 Little Mack Ave Ste 101
Saint Clair Shores, MI 48081-3017
Phone (586) 447-0700

Other practice location 1

22250 Providence Dr Ste 301A
Southfield, MI 48075-6211
Phone (248) 849-3281

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
I20160708002060 MI Practitioner - GastroenterologyPractitioner - General PracticePractitioner - Internal Medicine 7416258975 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Michigan State University College of Osteopathic Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gi Medical Assoc PCGroup PAC ID 3375525215, 11 clinicians

Practice addresses (Care Compare)

22250 Providence Dr
Suite 301a
Southfield, MI 48075-6211
Phone (248) 849-3281

28963 Little Mack Ave
Suite 101
Saint Clair Shores, MI 48081-3017
Phone (586) 447-0700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.49 of 100Reported as group
Quality
91.96
Promoting interoperability
100
Improvement activities
40
Cost
78.54

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy128
Upper gastrointestinal (GI) endoscopy for acid reflux108

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health Providence Hospital Multi-Specialty CurrentSince Feb 18, 2025 Accepting new patients
Henry Ford Health Providence Hospital Multi-Specialty CurrentSince Feb 18, 2025 Accepting new patients
Henry Ford Health Providence Hospital Multi-Specialty Current Accepting new patients

Locations

3168 Solutions Ctr
#773168
Chicago, IL 60677

16001 W 9 Mile Rd
Southfield, MI 48075
Phone (248) 424-3000

22250 Providence Dr
Ste 301A
Southfield, MI 48075
Phone (248) 849-3254

Interoperability endpoints

  • Direct secure messaging: lshamban437041@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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1337644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758499200000",
    "number": "1225398431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28963 LITTLE MACK AVE STE 101",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480813017",
            "telephone_number": "586-447-0700",
            "fax_number": "586-447-0795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28963 LITTLE MACK AVE STE 101",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480813017",
            "telephone_number": "586-447-0700",
            "fax_number": "586-498-0707"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22250 Providence Dr Ste 301A",
            "address_purpose": "LOCATION",
            "city": "Southfield",
            "state": "MI",
            "postal_code": "480756211",
            "country_code": "US",
            "telephone_number": "248-849-3281",
            "fax_number": "248-849-5449",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAMBAN",
        "first_name": "LEONID",
        "middle_name": "MIRONOVICH",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-05-22",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MI",
            "license": "5101019763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

Verify at the official NPI Registry.