NPIMap

Individual provider Active NPI

Mackenzie Nicole Difiore, NP

  • Family Nurse Practitioner
  • Troy, MI
National Provider Identifier
1285202416
Registry record updated Feb 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704343602 Issued in MI
Practice address
264 W Maple Rd Ste 200
Troy, MI 48084-5458
Phone
(248) 273-9930
NPI assigned
Jun 14, 2021
Last updated
Feb 12, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704343602 MI Primary

Addresses

Primary practice location

264 W Maple Rd Ste 200
Troy, MI 48084-5458

Mailing address

15295 Crestwood Dr
Macomb, MI 48044-1912

Other names 1

  • Mackenzie Nicole Maltese Former name

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
I20250310001183 MI Practitioner - Nurse Practitioner 8022539899 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Gastrointestinal Specialists PCGroup PAC ID 4880590264, 16 clinicians

Practice addresses (Care Compare)

264 W Maple Rd
Suite 200
Troy, MI 48084-5458
Phone (248) 273-9930

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704343602MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Gastrointestinal Specialists PC CurrentSince Jan 20, 2025 Accepting new patients
Essential Anesthesia Services, PLC CurrentSince Jan 20, 2025 Accepting new patients

Locations

264 W Maple Rd
Ste 200
Troy, MI 48084
Phone (248) 273-9930

Interoperability endpoints

  • Direct secure messaging: mdifiore1125233@direct.hfhs.org

Organizations & group practices 2

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1623628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739318400000",
    "number": "1285202416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15295 CRESTWOOD DR",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480441912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "264 W MAPLE RD STE 200",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480845458",
            "telephone_number": "248-273-9930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIFIORE",
        "first_name": "MACKENZIE",
        "middle_name": "NICOLE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-14",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704343602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MACKENZIE",
            "last_name": "MALTESE",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Troy, MI

Sources for this page

Verify at the official NPI Registry.