MRS. ETHEL MBOMBOW (PA-C) – Physician Assistant, NPI 1801121348
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
6,066 PHYSICIAN ASSISTANT in MI
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Provider Addresses for MRS. ETHEL MBOMBOW (PA-C)
Crooks Road, Troy, Oakland County, Michigan, 48098, United States
STE 130
TROY, MI 480985801
Phone: (248) 952-1601
Fax: (248) 952-1614
Type: Mailing
21409, Kelly Road, Eastpointe, Macomb County, Michigan, 48021, United States
SUITE 400
EASTPOINTE, MI 480213264
Phone: (586) 777-0630
Fax: (586) 777-0631
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $242.
Total Amount is formed as General ($242) + Research ($0) + Ownership ($0) = $242.
Last reported payment date: 2024-09-18 • Largest payer in this snapshot: Vanda Pharmaceuticals Inc. ($122).
Total Amount
$242
General + Research + Ownership
Payments
2
Total payment records
General Amount
$242
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-09-18
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Vanda Pharmaceuticals Inc. | $122 |
| Axsome Therapeutics, Inc. | $120 |
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: 2010-08-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| I20100830000719 | I | Physician Assistant | MI | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 174 | 51 | $0 |
Insurance plans in this area (ZIP 48098)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MI | |
| Clinical Social Worker | MI | |
| Mental Health Counselor | MI | |
| - | MI | |
| Physician Assistant | MI | |
| - | MI | |
| Psychiatry, Neurology | MI | |
| - | MI | |
| - | MI | |
| - | MI |
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