Tamra Gladys Maynie Maben, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301068281 Issued in MI

Practice address

5325 Folkstone Dr
Troy, MI 48085-3271

Phone

(248) 227-0258

NPI assigned

Aug 31, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: tamramaben@smomsjhsys.allscriptsdirect.net

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.

• Dedicated Physicians Group of Michigan, PLLC

  • Internal Medicine Physician
  • Miami Gardens, FL
  • NPI 1992392393

  MI

  Medicare reassignment
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  MI

  Medicare reassignment
• Dedicated Physicians Group of Michigan PLLC

  • Non-Pharmacy Dispensing Site
  • Detroit, MI
  • NPI 1366028730
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717718400000",
    "number": "1235240169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5325 FOLKSTONE DR",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480853271",
            "telephone_number": "248-227-0258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5325 FOLKSTONE DR",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480853271",
            "telephone_number": "248-227-0258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MABEN",
        "first_name": "TAMRA",
        "middle_name": "GLADYS MAYNIE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01086192A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301068281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://20799.portal.athenahealth.com",
            "affiliation": "N",
            "address_1": "1777 Axtell Dr Ste 105",
            "city": "Troy",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480844400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Grace Marie Lynch, SLP
• M Mounir Gazayerli MD PC
• Danny Ma, MD
• Hongwei Ma
• Ngoc Christina Ma, RPH
• Markia Mabin
• Sarah Macdonald
• Jessica M Macdougall, PA
• Angela Catherine Maceri
• Carlie Maceri, PA-C

• Family Medicine Physician in Troy, MI
• Providers in Troy, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 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; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.