Individual provider Active NPI

David Okeoghene Malaka, MD

  • Family Medicine Physician
  • Saint Joseph, MI
National Provider Identifier
1548568066
Registry record updated Jun 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301103741 Issued in MI
Practice address
1234 Napier Ave
Saint Joseph, MI 49085-2112
Phone
(269) 985-4632
Fax
(269) 985-4623
NPI assigned
Mar 8, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301103741 MI Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1234 Napier Ave
Saint Joseph, MI 49085-2112

Mailing address

6416 Deans Hill Rd
Berrien Center, MI 49102-9750
Phone (269) 985-4632

Other identifiers 1

IdentifierTypeStateIssuer
1548568066MedicaidMI

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130913000172 MI Practitioner - Family Practice 5698919629 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeland Medical PracticesGroup PAC ID 1658427042, 286 clinicians

Practice addresses (Care Compare)

1234 Napier Ave
Saint Joseph, MI 49085-2112
Phone (269) 983-8300

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Intercare Community Health Network CurrentSince Aug 6, 2013 Accepting new patients
Lakeland Medical Practices CurrentSince Jul 1, 2013 Accepting new patients
Lakeland Medical Practices CurrentSince Jul 1, 2013 Accepting new patients
Intercare Community Health Network CurrentSince Aug 6, 2013 Accepting new patients
Lakeland Hospitals at Niles and St Joseph, Inc Past Accepting new patients

Locations

50 Industrial Park Rd
Bangor, MI 49013
Phone (269) 427-7937

800 M 139
Benton Harbor, MI 49022
Phone (269) 927-5400

6416 Deans Hill Rd
Berrien Ctr, MI 49102
Phone (269) 471-7741

3950 Hollywood Rd
Ste 280
Saint Joseph, MI 49085
Phone (269) 408-0990

1234 Napier Ave
Saint Joseph, MI 49085
Phone (269) 982-4941

Interoperability endpoints

  • Direct secure messaging: dmalaka1270657@epic00.corewelldirect.org

Organizations & group practices 5

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 2

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": "1299542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372118400000",
    "number": "1548568066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6416 DEANS HILL RD",
            "city": "BERRIEN CENTER",
            "state": "MI",
            "postal_code": "491029750",
            "telephone_number": "269-985-4632",
            "fax_number": "269-985-4623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1234 NAPIER AVE",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490852112",
            "telephone_number": "269-985-4632",
            "fax_number": "269-985-4623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALAKA",
        "first_name": "DAVID",
        "middle_name": "OKEOGHENE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-08",
        "last_updated": "2013-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301103741",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1548568066",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MI

Sources for this page

Verify at the official NPI Registry.