NPIMap

Individual provider Active NPI

Boniface Atakekor Tubie, M.D.

  • Nephrology Physician
  • Southfield, MI
National Provider Identifier
1821144577
Registry record updated Mar 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
4301072901 Issued in MI
Practice address
20755 Greenfield Rd
Suite # 203
Southfield, MI 48075-5403
Phone
(248) 395-2206
Fax
(248) 395-0456
NPI assigned
Jan 26, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 9, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301072901 MI
Nephrology Specialist/Technologist 246ZN0300X 4301072901 MI
Nephrology Physician 207RN0300X 4301072901 MI Primary

Addresses

Primary practice location

20755 Greenfield Rd
Suite # 203
Southfield, MI 48075-5403

Mailing address

20755 Greenfield Rd
Suite # 203
Southfield, MI 48075-5403
Phone (248) 395-2206

Other identifiers 1

IdentifierTypeStateIssuer
4341231MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL eClinicalWorks Health Information Exchange (HIE)

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
I20070126000223 MI Practitioner - NephrologyPractitioner - Internal Medicine 5799697579 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

20755 Greenfield Rd
Southfield, MI 48075-5405
Phone (248) 395-2206

20755 Greenfield Rd
Suite 203
Southfield, MI 48075-5403

Hospital & facility affiliations

  • Dialysis Care Center Great Lakes West Dialysis facility, Southfield, MI, CCN 232695
  • Dialysis Care Center Great Lakes East Dialysis facility, Detroit, MI, CCN 232614
  • DaVita Schaeffer Drive Dialysis Dialysis facility, Detroit, MI, CCN 232583
  • Harper University Hospital Hospital, Detroit, MI, CCN 230104
  • Detroit Receiving Hospital Hospital, Detroit, MI, CCN 230273
  • Ascension Providence Hospital, Southfield and Novi Hospital, Southfield, MI, CCN 230019
  • Sinai-Grace Hospital Hospital, Detroit, MI, CCN 230024
  • Beaumont Hospital - Grosse Pointe Hospital, Grosse Pointe, MI, CCN 230089

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301072906MIMDPediatric Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Delta Renal Group, P.C. Nephrology CurrentSince Aug 1, 2001 Accepting new patients
Great Lakes Dialysis West LLC Current Accepting new patients
Cottab Medical Group, PLLC Internal Medicine Past Accepting new patients
Deon D Middlebrook M D PC Internal Medicine Past Accepting new patients
St Clair Specialty Physicians PC Nephrology Past Accepting new patients
Great Lakes Dialysis, L.L.C. PastSince Nov 6, 2003 Accepting new patients

Locations

20755 Greenfield Rd
Ste 203
Southfield, MI 48075
Phone (248) 395-2206

27150 W 8 Mile Rd
Southfield, MI 48033
Phone (248) 249-3475

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CGIEBA/Endpoint/CGIEBA
  • Direct secure messaging: btubie1156016@direct.hfhs.org
  • Direct secure messaging: boniface.tubie@deltarenal.eclinicaldirectplus.com
  • FHIR API: https://api.platform.athenahealth.com/16674/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir4.healow.com/fhir/r4/CGIEBA

Organizations & group practices 6

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": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646784000000",
    "number": "1821144577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20755 GREENFIELD RD",
            "address_2": "SUITE # 203",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480755403",
            "telephone_number": "248-395-2206",
            "fax_number": "248-395-0456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20755 GREENFIELD RD",
            "address_2": "SUITE # 203",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480755403",
            "telephone_number": "248-395-2206",
            "fax_number": "248-395-0456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUBIE",
        "first_name": "BONIFACE",
        "middle_name": "ATAKEKOR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-26",
        "last_updated": "2022-03-09",
        "certification_date": "2022-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301072901",
            "primary": false
        },
        {
            "code": "246ZN0300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Nephrology",
            "state": "MI",
            "license": "4301072901",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MI",
            "license": "4301072901",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4341231",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "eClinicalWorks",
            "affiliation": "N",
            "endpointDescription": "EMR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "EMR",
            "address_1": "20755 Greenfield Rd",
            "address_2": "Suite # 203",
            "city": "Southfield",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480755403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.