Active NPI
Amanda Provost Cimino, DO
- Internal Medicine Physician
- Dearborn, MI
National Provider Identifier
1417579186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 5315216509
- Practice address
- 17000 Hubbard Dr
Dearborn, MI 48126-4258 - Phone
- (313) 982-4351
- NPI assigned
- May 15, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 5315216509 | MI | Primary |
Addresses
Primary practice location
17000 Hubbard Dr
Dearborn, MI 48126-4258
Mailing address
26901 Beaumont Blvd Ste 3D
Southfield, MI 48033-3849
Phone (947) 522-1922
Other practice location 1
28050 Grand River Ave
Farmington Hills, MI 48336-5919
Phone (947) 521-8000
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | aprovost593315@direct.beaumont.edu | Direct |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Michigan State University College of Osteopathic Medicine, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
17000 Hubbard Dr
Dearborn, MI 48126-4258
Phone (313) 982-4351
201 3Rd St
Suite 200
Belleville, MI 48111-2605
Phone (734) 697-9065
28050 Grand River Ave
Farmington Hills, MI 48336-5919
Phone (947) 521-8196
Hospital & facility affiliations
- Beaumont Home Health
- Beaumont Hospital - Farmington Hills
- Beaumont Hospital - Dearborn
- Beaumont Hospital Royal Oak
- Beaumont Hospital - Taylor
- Corewell Health Wayne Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal or shaving of skin growth | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5315216509 | MI | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oakwood Ambulatory LLC | Internal Medicine | Current | Accepting new patients |
| Oakwood Ambulatory, LLC | Current | Accepting new patients |
Locations
201 3rd St
Ste 200
Belleville, MI 48111
Phone (734) 697-9065
17000 Hubbard Dr
Dearborn, MI 48126
Phone (313) 271-3802
28050 Grand River Ave
Farmington Hills, MI 48336
Phone (248) 471-8000
26901 Beaumont Blvd
Ste 3D
Southfield, MI 48033
Phone (947) 522-1860
Interoperability endpoints
- acimino1228935@epic00.shdirect.org
- acimino779541@direct.hfhs.org
- aprovost593315@direct.beaumont.edu
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 and National Provider Directory roles.
-
- Internal Medicine Physician
- Dearborn, MI
- NPI 1003829441
-
- Podiatrist
- Westland, MI
- NPI 1013157361
Hospital & facility affiliations 16
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Troy, MI
- NPI 1811461734
-
- General Acute Care Hospital
- Farmington Hills, MI
- NPI 1336183367
-
- General Acute Care Hospital
- Wayne, MI
- NPI 1295785285
-
- General Acute Care Hospital
- Taylor, MI
- NPI 1487605168
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1589500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687824000000",
"number": "1417579186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26901 BEAUMONT BLVD STE 3D",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480333849",
"telephone_number": "947-522-1922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17000 HUBBARD DR",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481264258",
"telephone_number": "313-982-4351"
}
],
"practiceLocations": [
{
"address_1": "28050 Grand River Ave",
"address_purpose": "LOCATION",
"city": "Farmington Hills",
"state": "MI",
"postal_code": "483365919",
"country_code": "US",
"telephone_number": "947-521-8000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CIMINO",
"first_name": "AMANDA",
"middle_name": "PROVOST",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-05-15",
"last_updated": "2023-06-27",
"certification_date": "2023-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "5315216509",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "aprovost593315@direct.beaumont.edu",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "17000 Hubbard Dr",
"city": "Dearborn",
"state": "MI",
"country_code": "US",
"postal_code": "481264258",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.