NPIMap

Organization Active NPI

Macomb Surgical Associates,P.C.

  • Surgery Physician
  • Clinton TWP, MI
National Provider Identifier
1295816932
Registry record updated Jul 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
013279 Issued in MI
Legal business name
MACOMB SURGICAL ASSOCIATES,P.C.
Practice address
21510 Harrington St Ste 102
Clinton TWP, MI 48036-2378
Phone
(586) 228-3800
Fax
(586) 228-9800
NPI assigned
Oct 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2024

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

Authorized official

Name
James J Giliberto Jr., DONPI 1629057054
Title
President
Phone
(586) 228-3800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X 013279 MI Primary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X 007081 MI
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X 008771 MI

Addresses

Primary practice location

21510 Harrington St Ste 102
Clinton TWP, MI 48036-2378

Mailing address

21510 Harrington St Ste 102
Clinton TWP, MI 48036-2378
Phone (586) 228-3800

Other identifiers 4

IdentifierTypeStateIssuer
4401008MedicaidMI
2125953MedicaidMI
4837559MedicaidMI
3464424MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060313000212 MI Part B Supplier - Clinic/Group Practice 7719994052 Receives reassigned benefits from 5 practitioners
Practice locations: Clinton TWP, MI

National Provider Directory

National Provider Directory

Locations

37400 Garfield Rd
Ste 120
Clinton Twp, MI 48036
Phone (586) 228-3800

21510 Harrington St
Ste 102
Clinton Twp, MI 48036
Phone (586) 228-3800

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721952000000",
    "number": "1295816932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21510 HARRINGTON ST STE 102",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480362378",
            "telephone_number": "586-228-3800",
            "fax_number": "586-228-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21510 HARRINGTON ST STE 102",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480362378",
            "telephone_number": "586-228-3800",
            "fax_number": "586-228-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACOMB SURGICAL ASSOCIATES,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A",
        "authorized_official_last_name": "GILIBERTO",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-228-3800",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "MI",
            "license": "013279",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "MI",
            "license": "007081",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "MI",
            "license": "008771",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4401008",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2125953",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4837559",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3464424",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton TWP, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.