NPIMap

Individual provider Active NPI

Vito Matteo Agrusa, DO

  • Family Medicine Physician
  • Southgate, MI
National Provider Identifier
1992371009
Registry record updated Jul 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101027836 Issued in MI
Practice address
14319 Dix Toledo Rd
Southgate, MI 48195-2506
Phone
(734) 285-0677
NPI assigned
May 29, 2021
Last updated
Jul 12, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2024

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 5101027836 MI Primary

Addresses

Primary practice location

14319 Dix Toledo Rd
Southgate, MI 48195-2506

Mailing address

26901 Beaumont Blvd Ste 3D
Southfield, MI 48033-3849
Phone (947) 522-1863

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address vagrusa966251@direct.beaumont.edu

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
I20240805001408 MI Practitioner - Family Practice 3577963487 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oakwood Ambulatory LLCGroup PAC ID 1850282914, 271 clinicians

Practice addresses (Care Compare)

14319 Dix Toledo Rd
Southgate, MI 48195-2506
Phone (734) 285-0677

201 3Rd St
Suite 200
Belleville, MI 48111-2605
Phone (734) 697-9065

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.72 of 100Reported as apm
Quality
87.24
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101027836MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oakwood Ambulatory LLC Family Medicine CurrentSince Sep 1, 2024 Accepting new patients
Oakwood Ambulatory, LLC CurrentSince Sep 1, 2024 Accepting new patients

Locations

201 3rd St
Ste 200
Belleville, MI 48111
Phone (734) 697-9065

26901 Beaumont Blvd
Ste 3D
Southfield, MI 48033
Phone (947) 522-1860

14319 Dix Toledo Rd
Southgate, MI 48195
Phone (734) 285-0677

33155 Annapolis St
Wayne, MI 48184
Phone (734) 467-4000

Interoperability endpoints

  • Direct secure messaging: vagrusa1222185@epic00.shdirect.org
  • Direct secure messaging: vagrusa966251@direct.beaumont.edu

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, 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": "1622246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720742400000",
    "number": "1992371009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849",
            "telephone_number": "947-522-1863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14319 DIX TOLEDO RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952506",
            "telephone_number": "734-285-0677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGRUSA",
        "first_name": "VITO",
        "middle_name": "MATTEO",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-29",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101027836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vagrusa966251@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "14319 Dix Toledo Rd",
            "city": "Southgate",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481952506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Southgate, MI

Sources for this page

Verify at the official NPI Registry.