Individual provider Active NPI

Praise Matemavi, D.O

  • Surgery Physician
  • Detroit, MI
National Provider Identifier
1558673731
Registry record updated Jul 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
5101018955 Issued in MI
Practice address
6071 W Outer Dr
Detroit, MI 48235-2624
Phone
(313) 966-1941
NPI assigned
Jul 5, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 5, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 5101018955 MI Primary

Addresses

Primary practice location

6071 W Outer Dr
Detroit, MI 48235-2624

Mailing address

29910 Green Acres
Farmington Hills, MI 48334-2136
Phone (269) 313-1856

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20190927000120 MS Practitioner - General Surgery 5496029985 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Michigan State University College of Osteopathic Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2500 N State St
Jackson, MS 39216-4500
Phone (601) 898-4404

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.94 of 100Reported as group
Quality
67.75
Promoting interoperability
100
Improvement activities
40
Cost
71.17

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101018955MIMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Jul 25, 2019 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Jul 25, 2019 Accepting new patients

Locations

163 River Oaks Dr
Ste 204
Canton, MS 39046
Phone (601) 855-4880

960 Avent Dr
Ste 105
Grenada, MS 38901

2500 N State St
Ste 4200
Jackson, MS 39216

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

2500 N State St
Ste J
Jackson, MS 39216

Interoperability endpoints

  • Direct secure messaging: pmatemavi134904@ummc.direct-ci.com

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.

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": "1278288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278288000000",
    "number": "1558673731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29910 GREEN ACRES",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483342136",
            "telephone_number": "269-313-1856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6071 W OUTER DR",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482352624",
            "telephone_number": "313-966-1941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATEMAVI",
        "first_name": "PRAISE",
        "credential": "D.O",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-05",
        "last_updated": "2010-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "5101018955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.