Michael Banoub, P.T., PHD.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501017184 Issued in MI

Practice address

1050 W University Dr
Suite3
Rochester, MI 48307-1877

Phone

(248) 650-1984

Fax

(248) 650-1994

NPI assigned

Jan 20, 2016

Last updated

Jan 20, 2016By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Marina Rehabilitation and Health Services IncGroup PAC ID 7618913237, 2 clinicians

JMK Physical Therapy PLLCGroup PAC ID 4284078890, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• JMK Physical Therapy PLLC

  • Physical Therapist
  • Sterling Heights, MI
  • NPI 1215704655
  Medicare reassignment Care Compare group NPD Authorized official
• Marina Rehabilitation and Health Services, Inc.

  • Physical Therapist
  • Rochester, MI
  • NPI 1902875941
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1453248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453248000000",
    "number": "1740647858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 W UNIVERSITY DR",
            "address_2": "SUITE3",
            "city": "ROCHESTER",
            "state": "MI",
            "postal_code": "483071877",
            "telephone_number": "248-650-1984",
            "fax_number": "248-650-1994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 W UNIVERSITY DR",
            "address_2": "SUITE3",
            "city": "ROCHESTER",
            "state": "MI",
            "postal_code": "483071877",
            "telephone_number": "248-650-1984",
            "fax_number": "248-650-1994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANOUB",
        "first_name": "MICHAEL",
        "credential": "P.T., PHD.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-01-20",
        "last_updated": "2016-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501017184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Rochester, MI
• Providers in Rochester, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.