NPIMap

Individual provider Active NPI

Kathleen M Maksimowicz-McKinnon, DO

  • Rheumatology Physician
  • Detroit, MI
National Provider Identifier
1922072602
Registry record updated Aug 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
5101014012 Issued in MI
Practice address
3031 W Grand Blvd Ste 800
Detroit, MI 48202-3141
Phone
(313) 916-2631
NPI assigned
Feb 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X OS013023 PA
Rheumatology Physician 207RR0500X 5101014012 MI Primary

Addresses

Primary practice location

3031 W Grand Blvd Ste 800
Detroit, MI 48202-3141

Mailing address

3031 W Grand Blvd Ste 800
Detroit, MI 48202-3141
Phone (313) 916-2631

Other identifiers 1

IdentifierTypeStateIssuer
101007671MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20220920000917 SC Practitioner - RheumatologyPractitioner - Internal Medicine 6608840764 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
RheumatologyAlso: Internal Medicine
Education
Nova Southeastern College of Osteo Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

171 Ashley Ave
Charleston, SC 29425-8908
Phone (843) 792-1414

Hospital & facility affiliations

  • Musc Medical Center Hospital, Charleston, SC, CCN 420004
  • Musc Health Columbia Medical Center Downtown Hospital, Columbia, SC, CCN 420026

Merit-based Incentive Payment System (MIPS)

Final score
79.02 of 100Reported as group
Quality
62.41
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
87800SCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Associates of the Medical University of South Carol Rheumatology Current Accepting new patients
University Medical Associates of the Medical University of South Carol CurrentSince Aug 10, 2022 Accepting new patients

Locations

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

Interoperability endpoints

  • Direct secure messaging: kmaksimowiczmckinnon405983@direct.musc.edu
  • Direct secure messaging: kmaksimowiczmckinnon59309@direct.hfhs.org

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 10

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": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406851200000",
    "number": "1922072602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3031 W GRAND BLVD STE 800",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023141",
            "telephone_number": "313-916-2631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3031 W GRAND BLVD STE 800",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023141",
            "telephone_number": "313-916-2631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAKSIMOWICZ-MCKINNON",
        "first_name": "KATHLEEN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-17",
        "last_updated": "2014-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "OS013023",
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "MI",
            "license": "5101014012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101007671",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.