Organization Active NPI

Home MD PLLC

  • Adult Medicine Physician
  • Waterford, MI
National Provider Identifier
1407747215
Registry record updated Jul 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
Legal business name
HOME MD PLLC
Practice address
4568 W Walton Blvd Ste D
Waterford, MI 48329-4900
Phone
(855) 466-3631
Fax
(833) 973-4493
NPI assigned
Jul 10, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2025

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

Authorized official

Name
Deborah Vaubel
Title
Administrator
Phone
(810) 620-0398

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0505X Primary

Addresses

Primary practice location

4568 W Walton Blvd Ste D
Waterford, MI 48329-4900

Mailing address

4568 W Walton Blvd Ste D
Waterford, MI 48329-4900
Phone (855) 466-3631

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250822000745 MI Part B Supplier - Clinic/Group Practice 5193225399 Receives reassigned benefits from 1 practitioner
Practice locations: Waterford, MI

National Provider Directory

National Provider Directory

Locations

4568 W Walton Blvd
Ste D
Waterford Township, MI 48329
Phone (855) 466-3631

Practitioners & affiliated clinicians

Practitioners 1

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": "1752105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752105600000",
    "number": "1407747215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4568 W WALTON BLVD STE D",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483294900",
            "telephone_number": "855-466-3631",
            "fax_number": "833-973-4493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4568 W WALTON BLVD STE D",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483294900",
            "telephone_number": "855-466-3631",
            "fax_number": "833-973-4493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOME MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-10",
        "last_updated": "2025-07-10",
        "certification_date": "2025-07-10",
        "status": "A",
        "authorized_official_last_name": "VAUBEL",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "810-620-0398"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2025; 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.