NPIMap

Individual provider Active NPI

Mario JC De Meireles, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Dearborn, MI
National Provider Identifier
1255335097
Registry record updated Mar 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
4301061758 Issued in MI
Practice address
23874 Kean St
Dearborn, MI 48124-1851
Phone
(313) 359-0801
Fax
(313) 359-2674
NPI assigned
Jun 9, 2005
Last updated
Mar 31, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301061758 MI
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 4301061758 MI Primary

Addresses

Primary practice location

23874 Kean St
Dearborn, MI 48124-1851

Mailing address

26850 Providence Parkway
Pmob#200
Novi, MI 48374
Phone (248) 465-3144

Other identifiers 1

IdentifierTypeStateIssuer
3326713 10MedicaidMI

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
I20060717000146 MI Practitioner - Internal MedicinePractitioner - Geriatric Medicine 8921993163 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

9260 Fellows Creek Dr
Plymouth, MI 48170-6354
Phone (248) 302-7686

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301061758MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mario de Meireles MD Mhsa PC Internal Medicine CurrentSince Jan 30, 2008 Accepting new patients
Henry Ford Health Providence Hospital CurrentSince Aug 15, 1999 Accepting new patients
Henry Ford Health Providence Hospital Internal Medicine CurrentSince Aug 15, 1999 Accepting new patients
Henry Ford Health Providence Hospital Current Accepting new patients
Chaplains, Inc. Past Accepting new patients

Locations

23874 Kean St
Dearborn, MI 48124
Phone (248) 465-5140

23874 Kean St
Ste 100
Dearborn, MI 48124
Phone (248) 865-9898

26850 Providence Pkwy
Ste 200
Novi, MI 48374

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

16001 W 9 Mile Rd
Fl 5
Southfield, MI 48075
Phone (248) 380-4335

Interoperability endpoints

  • Direct secure messaging: mdemeireles1124715@direct.hfhs.org

Organizations & group practices 5

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 3

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": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585612800000",
    "number": "1255335097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26850 PROVIDENCE PARKWAY",
            "address_2": "PMOB#200",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "48374",
            "telephone_number": "248-465-3144",
            "fax_number": "248-465-3146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23874 KEAN ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241851",
            "telephone_number": "313-359-0801",
            "fax_number": "313-359-2674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE MEIRELES",
        "first_name": "MARIO",
        "middle_name": "JC",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2020-03-31",
        "certification_date": "2020-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301061758",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MI",
            "license": "4301061758",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3326713 10",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.