NPIMap

Individual provider Active NPI

Saimabanu S Mansuri, M.D.

  • Nephrology Physician
  • Royal Oak, MI
National Provider Identifier
1467629493
Registry record updated Oct 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
4301090163 Issued in MI
Practice address
3535 W 13 Mile Rd # 248
Beaumont Chronic Disease Management Clinic
Royal Oak, MI 48073-6770
Phone
(248) 551-1515
Fax
(248) 551-1516
NPI assigned
May 8, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 4301090163 MI Primary

Addresses

Primary practice location

3535 W 13 Mile Rd # 248
Beaumont Chronic Disease Management Clinic
Royal Oak, MI 48073-6770

Mailing address

130 Town Center Dr Ste 203
Beaumont Medical Staff Affairs
Troy, MI 48084-1744
Phone (248) 585-8218

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address smansuri144169@direct.beaumont.edu

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
I20160712000165 MI Practitioner - NephrologyPractitioner - Sleep Medicine 6507043981 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Sleep Medicine
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

28100 Grand River Ave
Farmington Hills, MI 48336-5970

3535 W 13 Mile Rd
Royal Oak, MI 48073-6770

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712

3601 W 13 Mile Rd Ec
Beaumont Emergency Services Ro
Royal Oak, MI 48073-6712
Phone (248) 898-5058

44201 Dequindre Rd
Troy, MI 48085-1117
Phone (248) 964-0535

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.37 of 100Reported as group
Quality
66.73
Promoting interoperability
100
Improvement activities
40
Cost
70.98

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
William Beaumont Hospital CurrentSince Jul 31, 2016 Accepting new patients
William Beaumont Hospital Current Accepting new patients
William Beaumont Hospital CurrentSince Jul 31, 2016 Accepting new patients
Beaumont Medical Group- Specialty Services CurrentSince Mar 24, 2018 Accepting new patients
William Beaumont Hospital Past Accepting new patients
Great Lakes Medicine, PLC Past Accepting new patients

Locations

28100 Grand River Ave
Ste 301
Farmington Hills, MI 48336
Phone (947) 521-1320

15959 Hall Rd
Ste LL-100
Macomb, MI 48044
Phone (586) 416-5920

3535 W 13 Mile Rd
Ste 248
Royal Oak, MI 48073
Phone (248) 551-1515

3535 W 13 Mile Rd
#248
Royal Oak, MI 48073
Phone (248) 551-1515

3535 W 13 Mile Rd
Ste 247
Royal Oak, MI 48073
Phone (248) 288-9340

26001 Jefferson Ave
Saint Clair Shores, MI 48081
Phone (586) 779-7000

130 Town Center Dr
Ste 203
Troy, MI 48084
Phone (248) 585-8250

Interoperability endpoints

  • Direct secure messaging: smansuri144169@direct.beaumont.edu
  • Direct secure messaging: smansuri1245040@epic00.shdirect.org

Organizations & group practices 6

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.

Hospital & facility affiliations 4

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": "1210204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1467629493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 TOWN CENTER DR STE 203",
            "address_2": "BEAUMONT MEDICAL STAFF AFFAIRS",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480841744",
            "telephone_number": "248-585-8218",
            "fax_number": "248-585-8266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 W 13 MILE RD # 248",
            "address_2": "BEAUMONT CHRONIC DISEASE MANAGEMENT CLINIC",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736770",
            "telephone_number": "248-551-1515",
            "fax_number": "248-551-1516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSURI",
        "first_name": "SAIMABANU",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-08",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MI",
            "license": "4301090163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smansuri144169@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "3535 W 13 Mile Rd # 248",
            "address_2": "Beaumont Chronic Disease Management Clinic",
            "city": "Royal Oak",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480736770",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Royal Oak, MI

Sources for this page

Verify at the official NPI Registry.