NPIMap

Individual provider Active NPI

Vincent Dematio

  • Internal Medicine Physician
  • Escanaba, MI
National Provider Identifier
1982067096
Registry record updated Oct 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301118997 Issued in MI
Practice address
2525 7TH Ave S
Escanaba, MI 49829-1131
Phone
(248) 860-4634
NPI assigned
Apr 5, 2016
Last updated
Oct 12, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 12, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35.134465 OH
Internal Medicine Physician 207R00000X 4301118997 MI Primary

Addresses

Primary practice location

2525 7TH Ave S
Escanaba, MI 49829-1131

Mailing address

4954 Stillwagon Rd
West Branch, MI 48661-9662

Other practice location 1

2415 5th Ave S
Escanaba, MI 49829-1201
Phone (248) 860-4634

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, ND2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190710000831 MI Practitioner - Internal MedicinePractitioner - Hospitalist 7911290010 Reassigns benefits to 2 organizations
I20230125002149 ND Practitioner - Hospitalist 7911290010 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Innovis Health LLCGroup PAC ID 9931298155, 561 clinicians

Practice addresses (Care Compare)

3000 32ND Ave S
Fargo, ND 58103-6132
Phone (701) 364-8000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301118997MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Innovis Health, LLC. CurrentSince Dec 20, 2022 Accepting new patients
Innovis Health LLC CurrentSince Dec 20, 2022 Accepting new patients
Innovis Health, LLC Single Specialty Current Accepting new patients
Iha Health Services Corporation CurrentSince Jan 1, 2022 Accepting new patients
West Branch Regional Medical Center Single Specialty Current Accepting new patients
Iha Health Services Corporation Single Specialty Current Accepting new patients
Theoria Medical Single Specialty CurrentSince Sep 17, 2021 Accepting new patients
Iha Health Service Corporation CurrentSince Jan 1, 2022 Accepting new patients
Theoria Medical Internal Medicine Past Accepting new patients
Wellbridge of Clarkston, LLC Past Accepting new patients

Locations

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

128 Van Buren St
Chelsea, MI 48118
Phone (734) 475-8677

5655 Clarkston Rd
Clarkston, MI 48348
Phone (810) 623-5216

2415 5th Ave S
Escanaba, MI 49829
Phone (906) 786-6907

2525 7th Ave S
Escanaba, MI 49829
Phone (906) 786-0408

3139 E Baldwin Rd
Grand Blanc, MI 48439
Phone (810) 445-5300

41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763

44428 Woodward Ave
Ste 102
Pontiac, MI 48341
Phone (734) 712-8700

2463 S M 30
West Branch, MI 48661
Phone (517) 345-3660

5301 McAuley Dr
Ypsilanti, MI 48197
Phone (734) 712-7246

1702 University Dr S
Fargo, ND 58103
Phone (701) 364-4222

3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000

Organizations & group practices 10

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 7

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": "1459814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633996800000",
    "number": "1982067096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4954 STILLWAGON RD",
            "city": "WEST BRANCH",
            "state": "MI",
            "postal_code": "486619662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 7TH AVE S",
            "city": "ESCANABA",
            "state": "MI",
            "postal_code": "498291131",
            "telephone_number": "248-860-4634"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2415 5th Ave S",
            "address_purpose": "LOCATION",
            "city": "Escanaba",
            "state": "MI",
            "postal_code": "498291201",
            "country_code": "US",
            "telephone_number": "248-860-4634",
            "fax_number": "248-282-5044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEMATIO",
        "first_name": "VINCENT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-05",
        "last_updated": "2021-10-12",
        "certification_date": "2021-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35.134465",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301118997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Escanaba, MI

Sources for this page

Verify at the official NPI Registry.