NPIMap

Individual provider Active NPI

Antonino G Colombo, M.D.

  • Family Medicine Physician
  • Lenox, MI
National Provider Identifier
1598867491
Registry record updated Apr 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301082157 Issued in MI
Practice address
36267 26 Mile Road
Suite 3
Lenox, MI 48048-3166
Phone
(586) 716-1371
Fax
(586) 716-4855
NPI assigned
Sep 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301082157 MI Primary

Addresses

Primary practice location

36267 26 Mile Road
Suite 3
Lenox, MI 48048-3166

Mailing address

36267 26 Mile Road
Suite 3
Lenox, MI 48048-3166
Phone (586) 716-1371

Other identifiers 2

IdentifierTypeStateIssuer
4301082157OtherMISTATE LICENSE
1598867491MedicaidMI

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
I20061101000559 MI Practitioner - Family Practice 0941207070 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Healthcare Network PCGroup PAC ID 3476456252, 30 clinicians

Practice addresses (Care Compare)

3350 Gratiot Blvd
Marysville, MI 48040-2121
Phone (810) 364-4000

36267 26 Mile Rd
Suite 3
Lenox, MI 48048-3253
Phone (586) 716-1371

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301082157MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Healthcare Network, PC Family Medicine CurrentSince Sep 5, 2006 Accepting new patients

Locations

10127 Marine City Hwy
Ira, MI 48023
Phone (586) 716-1371

36267 26 Mile Rd
Ste 3
Lenox, MI 48048
Phone (586) 716-1371

3350 Gratiot Blvd
Marysville, MI 48040
Phone (810) 364-4000

Interoperability endpoints

  • Direct secure messaging: antonino.colombo.1@11357.direct.athenahealth.com
  • Direct secure messaging: acolombo431132@direct.hfhs.org
  • Direct secure messaging: acolombo1123672@direct.hfhs.org

Organizations & group practices 1

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 9

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": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491350400000",
    "number": "1598867491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36267 26 MILE ROAD",
            "address_2": "SUITE 3",
            "city": "LENOX",
            "state": "MI",
            "postal_code": "480483166",
            "telephone_number": "586-716-1371",
            "fax_number": "586-716-4855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36267 26 MILE ROAD",
            "address_2": "SUITE 3",
            "city": "LENOX",
            "state": "MI",
            "postal_code": "480483166",
            "telephone_number": "586-716-1371",
            "fax_number": "586-716-4855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLOMBO",
        "first_name": "ANTONINO",
        "middle_name": "G",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-01",
        "last_updated": "2017-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301082157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "4301082157",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1598867491",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lenox, MI

Sources for this page

Verify at the official NPI Registry.