Michael Joseph Charboneau Jr., DO

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

5101010247 Issued in MI

Practice address

730 N Macomb St
Suite 329
Monroe, MI 48162-2900

Phone

(734) 240-5860

Fax

(734) 240-5899

NPI assigned

Aug 5, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

Electronic endpoints 1

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

Specialty

General Surgery

Education

Des Moines University of Osteopathic Medicine and Health Sciences, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Promedica Monroe PhysiciansGroup PAC ID 2365696176, 64 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Promedica Monroe Regional Hospital Hospital, Monroe, MI, CCN 230099
• Promedica Toledo Hospital Hospital, Toledo, OH, CCN 360068

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mcharboneau22499@direct.promedica.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Promedica Monroe Physicians

  • Family Medicine Physician
  • Toledo, OH
  • NPI 1194078055

  MI

  Medicare reassignment Care Compare group
• Mercy Memorial Hospital Corporatio

  dba Promedica Monroe Regional Hospital

  • General Acute Care Hospital
  • Monroe, MI
  • NPI 1811097223
  Medicare reassignment NPD
• Michael J Charboneau Jr DO PLLC

  • Surgery Physician
  • Monroe, MI
  • NPI 1104092337
  Authorized official Same address or phone
• Mercy Memorial Hospital Corporation

  dba Monroe Cancer Center

  • Specialist
  • Monroe, MI
  • NPI 1376997551
  NPD
• Mercy Memorial Hospital Corporation

  dba Family Medicine Residency Center

  • Family Medicine Physician
  • Monroe, MI
  • NPI 1659614022
  NPD
• Promedica Central Corporation of Michigan

  • Family Medicine Physician
  • Toledo, OH
  • NPI 1588624696

  Surgery

  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mercy Memorial Hospital Corporatio

  dba Promedica Monroe Regional Hospital

  • General Acute Care Hospital
  • Monroe, MI
  • NPI 1811097223
  Care Compare affiliation
• Mercy Memorial Hospital Corporation

  dba Monroe Cancer Center

  • Specialist
  • Monroe, MI
  • NPI 1376997551

  Hospital

  Care Compare affiliation
• The Toledo Hospital

  • General Acute Care Hospital
  • Toledo, OH
  • NPI 1407854771
  Care Compare affiliation
• Toledo Hospital

  dba ProMedica Transportation Network

  • Ambulance
  • Toledo, OH
  • NPI 1427147339

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1619986213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SEAGATE",
            "address_2": "# 800",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041558",
            "telephone_number": "567-585-1983",
            "fax_number": "419-824-7359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 N MACOMB ST",
            "address_2": "SUITE 329",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481622900",
            "telephone_number": "734-240-5860",
            "fax_number": "734-240-5899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHARBONEAU",
        "first_name": "MICHAEL",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "5101010247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAP",
            "identifier": "G22695",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLAN OF MICHIGAN",
            "identifier": "11684",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORD",
            "identifier": "0255810524",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "020046979",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4218443",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0255810524",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mcharboneau22499@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cawood Chiropractic Center
• Matthew Paul Cawood, D.C.
• Centered Space LLC
• Chalet of Monroe LLC
• Kellyn O'Brady Chapman, PA-C
• Dominic D Charles, DC
• Noel Sudarsan Chatla, PHYSICAL THERAPIST
• Michael S Chen, DO
• Jennifer Chesman
• CHI Power X2 Consulting, LLC (Integral Health Partners)

• Surgery Physician in Monroe, MI
• Providers in Monroe, MI by specialty
• Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 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.

Verify at the official NPI Registry.