NPIMap

Individual provider Active NPI

Anthony Paniccia, MD

  • Family Medicine Physician
  • St Clair Shores, MI
National Provider Identifier
1891761821
Registry record updated Dec 6, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301070278 Issued in MI
Practice address
19901 E 10 Mile Rd
St Clair Shores, MI 48080-1069
Phone
(586) 777-1277
Fax
(586) 777-0106
NPI assigned
Feb 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2007

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 4301070278 MI Primary

Addresses

Primary practice location

19901 E 10 Mile Rd
St Clair Shores, MI 48080-1069

Mailing address

43800 Garfield Rd
Suite 201
Clinton TWP, MI 48038-1136
Phone (800) 848-0202

Other identifiers 3

IdentifierTypeStateIssuer
0P27380OtherMIMEDICARE GROUP LEGACY #
4588604MedicaidMI
0501046OtherMIBCBS PIN

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
I20040508000260 MI Practitioner - Family Practice 6103815840 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Health St. John HospitalGroup PAC ID 3173424082, 332 clinicians

Practice addresses (Care Compare)

19901 E 10 Mile Rd
Harper Family Practice
St Clair Shores, MI 48081-1069
Phone (586) 777-1277

Hospital & facility affiliations

  • Henry Ford Health St John Hospital Hospital, Detroit, MI, CCN 230165
  • Henry Ford Health Warren Hospital Hospital, Warren, MI, CCN 230195
  • Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health St. John Hospital Current Accepting new patients
Henry Ford Health St. John Hospital CurrentSince Oct 1, 2011 Accepting new patients
Henry Ford Health St. John Hospital Family Medicine CurrentSince Oct 1, 2011 Accepting new patients
St. John Hospital Past Accepting new patients

Locations

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

46591 Romeo Plank Rd
Macomb, MI 48044
Phone (586) 226-6269

19901 E 10 Mile Rd
Saint Clair Shores, MI 48080
Phone (586) 777-1277

Interoperability endpoints

  • Direct secure messaging: apaniccia1143788@direct.hfhs.org

Organizations & group practices 4

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 4

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": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196899200000",
    "number": "1891761821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43800 GARFIELD RD",
            "address_2": "SUITE 201",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480381136",
            "telephone_number": "800-848-0202",
            "fax_number": "586-226-6949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19901 E 10 MILE RD",
            "city": "ST CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801069",
            "telephone_number": "586-777-1277",
            "fax_number": "586-777-0106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANICCIA",
        "first_name": "ANTHONY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-28",
        "last_updated": "2007-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301070278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP LEGACY #",
            "identifier": "0P27380",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4588604",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN",
            "identifier": "0501046",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Clair Shores, MI

Sources for this page

Verify at the official NPI Registry.