MR. MICHAEL C. MANDZIARA (PA) – Physician Assistant, NPI 1245632165
Physician Assistant
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
6,069 PHYSICIAN ASSISTANT in MI
Provider Addresses for MR. MICHAEL C. MANDZIARA (PA)
750 STEPHENSON HWY
TROY, MI 480831103
Phone: (248) 577-4995
Fax: (248) 577-3526
Type: Mailing
44201 DEQUINDRE RD
TROY, MI 480851117
Phone: (248) 964-5000
Type: Location
44201 Dequindre Rd
Troy, MI 480851117
Phone: (248) 964-5000
Type: Location
PO BOX 421
LIBERTY LAKE, WA 990190421
Phone: (866) 747-2455
Fax: (509) 227-7070
Type: Mailing
9631 N NEVADA ST STE 300
SPOKANE, WA 992181193
Phone: (509) 465-3919
Fax: (509) 227-7070
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2023-11-10
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20220401000313 | I | Physician Assistant | WA | TBD |
| I20231110000462 | I | Physician Assistant | OR | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 48083)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | WA | |
| Internal Medicine | WA | |
| - | WA | |
| Physician Assistant | WA | |
| - | WA | |
| - | WA | |
| Physician Assistant | WA | |
| Internal Medicine | WA | |
| - | WA | |
| - | WA |
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