Thomas A Maibenco, MD

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

License

35295 Issued in OK

Practice address

1500 E Downing St Ste 101
Tahlequah, OK 74464-3354

Phone

(918) 453-1234

NPI assigned

Feb 12, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Northeastern Oklahoma Community Health Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Hulbert, OK
  • NPI 1518070481
  Medicare reassignment NPD
• Northeastern Oklahoma Community Health Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Pryor, OK
  • NPI 1669101184
  NPD

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583798400000",
    "number": "1639211386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "916 TALON DRIVE",
            "address_2": "SUITE 102",
            "city": "OFALLON",
            "state": "IL",
            "postal_code": "622691848",
            "telephone_number": "618-628-8211",
            "fax_number": "618-628-0883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E DOWNING ST STE 101",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744643354",
            "telephone_number": "918-453-1234"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "916 Talon Drive",
            "address_2": "Suite 102",
            "address_purpose": "LOCATION",
            "city": "OFallon",
            "state": "IL",
            "postal_code": "622691848",
            "country_code": "US",
            "telephone_number": "618-628-8211 x1100",
            "fax_number": "618-628-0883",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAIBENCO",
        "first_name": "THOMAS",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-12",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "IL",
            "license": "336078668",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "OK",
            "license": "35295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie R Macdonald
• James Regis Madison, DO
• Anna Amaris Madjarov
• Cedrick Mah, OD
• James Gibson Mahaney, O.D.
• Joel Acopio Malabrigo, M.D.
• Whitney Malott
• Terrah Lynn Manes, LCSW
• Naif Nasiruddin Mansury
• Jacqueline Manus, OTR/L

• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Tahlequah, OK
• Providers in Tahlequah, OK by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.