NPIMap

Individual provider Active NPI

Vincent Colina Maribao, MD

  • Internal Medicine Physician
  • Saint Clair Shores, MI
National Provider Identifier
1902835168
Registry record updated Oct 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301063323 Issued in MI
Practice address
29167 Jefferson Ave Ste 100
Saint Clair Shores, MI 48081-1331
Phone
(586) 498-1160
Fax
(586) 498-1168
NPI assigned
Jul 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 1, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301063323 MI Primary

Addresses

Primary practice location

29167 Jefferson Ave Ste 100
Saint Clair Shores, MI 48081-1331

Mailing address

29167 Jefferson Ave Ste 100
Saint Clair Shores, MI 48081-1331
Phone (586) 498-1160

Other identifiers 1

IdentifierTypeStateIssuer
4177064MedicaidMI

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
I20061012000117 MI Practitioner - Internal Medicine 3678578374 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Wayne State University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Powerback Rehabilitation LLCGroup PAC ID 2365359932, shared by 106 NPIs, 600 clinicians

Practice addresses (Care Compare)

29167 Jefferson Ave
Saint Clair Shores, MI 48081-1331

44003 Partridge Creek Blvd
Clinton TWP, MI 48038-0002
Phone (342) 627-3267

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.36 of 100Reported as individual
Quality
100
Promoting interoperability
68
Improvement activities
40
Cost
87.29

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Vincent R C Maribao MD PC Internal Medicine CurrentSince Jul 1, 2006 Accepting new patients
Joint Venture Hospital Laboratories PastSince Oct 6, 2019 Accepting new patients

Locations

29167 Jefferson Ave
Ste 100
St Clr Shores, MI 48081
Phone (586) 498-1160

21600 Harper Ave
St Clr Shores, MI 48080
Phone (586) 421-4003

Interoperability endpoints

  • Direct secure messaging: vmaribao1140177@direct.hfhs.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Serenity Hospice Care LLCLivonia, MI, CCN 231700 Hospice Contracted Managing Employee Jul 1, 2021

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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 12

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": "1151712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569888000000",
    "number": "1902835168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29167 JEFFERSON AVE STE 100",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811331",
            "telephone_number": "586-498-1160",
            "fax_number": "586-498-1168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29167 JEFFERSON AVE STE 100",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811331",
            "telephone_number": "586-498-1160",
            "fax_number": "586-498-1168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARIBAO",
        "first_name": "VINCENT",
        "middle_name": "COLINA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-01",
        "last_updated": "2019-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301063323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4177064",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

Verify at the official NPI Registry.