Mr Thomas A Maibenco, MD is a medicare enrolled "Physical Medicine & Rehabilitation - Pain Medicine" physician in Tahlequah, Oklahoma. His current practice location is
1500 E Downing St Ste 101, Tahlequah, Oklahoma. You can reach out to his office (for appointments etc.) via phone at
(918) 453-1234.
Mr Thomas A Maibenco is licensed to practice in Oklahoma (license number 35295) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1639211386.
Physician's Profile
| Full Name | Mr Thomas A Maibenco |
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| Gender | Male |
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| Speciality | Physical Medicine & Rehabilitation - Pain Medicine |
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| Location | 1500 E Downing St Ste 101, Tahlequah, Oklahoma |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1639211386
- Provider Enumeration Date: 02/12/2007
- Last Update Date: 03/10/2020
Medicare PECOS Information:
- PECOS PAC ID: 6709989320
- Enrollment ID: I20200327001977
Medical Identifiers
Medical identifiers for Mr Thomas A Maibenco such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1639211386 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 2081P2900X | Physical Medicine & Rehabilitation - Pain Medicine | 336078668 (Illinois) | Secondary |
| 2081P2900X | Physical Medicine & Rehabilitation - Pain Medicine | 35295 (Oklahoma) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mr Thomas A Maibenco allows following entities to bill medicare on his behalf.
| Entity Name | Northeastern Oklahoma Community Health Centers, Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1518070481
PECOS PAC ID: 3678482635
Enrollment ID: O20031104000417 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Thomas A Maibenco is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Mr Thomas A Maibenco, MD
916 Talon Drive, Suite 102,
Ofallon, IL 62269-1848
Ph: (618) 628-8211 | Mr Thomas A Maibenco, MD
1500 E Downing St Ste 101,
Tahlequah, OK 74464-3354
Ph: (918) 453-1234 |
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