Individual provider Active NPI

Bianca Mailloux

  • Critical Care Medicine Registered Nurse
  • Royal Oak, MI
National Provider Identifier
1922799071
Registry record updated May 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine Registered NurseTaxonomy code 163WC0200X
License
4704358882 Issued in MI
Practice address
4201 Kent Rd
Royal Oak, MI 48073-0002
Phone
(317) 993-9057
NPI assigned
May 18, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 18, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Registered Nurse 163WC0200X 4704358882 MI Primary

Addresses

Primary practice location

4201 Kent Rd
Royal Oak, MI 48073-0002

Mailing address

4201 Kent Rd
Royal Oak, MI 48073-0002

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230921001999 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 8426402629 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2023
Medicare assignment
May accept Medicare assignment
Group practices
Northstar Anesthesia of Michigan III PLLCGroup PAC ID 7911325469, 561 clinicians

Practice addresses (Care Compare)

33155 Annapolis St
Wayne, MI 48184-2405
Phone (214) 687-0001

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712
Phone (214) 687-0001

468 Cadieux Rd
Grosse Pointe, MI 48230-1507
Phone (214) 687-0001

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4704358882MIMDCritical Care Medicine Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Northstar Anesthesia of Michigan III PLLC CurrentSince Sep 20, 2023 Accepting new patients

Locations

33155 Annapolis St
Wayne, MI 48184
Phone (734) 467-4042

Organizations & group practices 1

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.

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": "1684368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684368000000",
    "number": "1922799071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 KENT RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480730002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 KENT RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480730002",
            "telephone_number": "317-993-9057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAILLOUX",
        "first_name": "BIANCA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-18",
        "last_updated": "2023-05-18",
        "certification_date": "2023-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "MI",
            "license": "4704358882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Royal Oak, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2023; 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.