NPIMap

Organization Active NPI

K Heart & Vascular Institute, PLLC

  • Cardiovascular Disease Physician
  • Sterling Heights, MI
National Provider Identifier
1003366675
Registry record updated Feb 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
K HEART & VASCULAR INSTITUTE, PLLC
Practice address
33376 Dequindre Road
Sterling Heights, MI 48310-5966
Phone
(586) 722-7440
Fax
(586) 722-7675
NPI assigned
Oct 7, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2019

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

Authorized official

Name
Dr. Srinivas Koneru, M.D.NPI 1477599587
Title
Physician
Phone
(586) 722-7440

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X Primary
Interventional Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0011X

Addresses

Primary practice location

33376 Dequindre Road
Sterling Heights, MI 48310-5966

Mailing address

33376 Dequindre Road
Sterling Heights, MI 48310-5966
Phone (586) 722-7440

Other identifiers 3

IdentifierTypeStateIssuer
0501427OtherMIBLUE CROSS BLUE SHIELD OF MICHIGAN
0E05972OtherMIBLUE CROSS BLUE SHIELD OF MICHIGAN
1477599587MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180118000942 MI Part B Supplier - Clinic/Group Practice 4789943887 Receives reassigned benefits from 12 practitioners
Practice locations: Sterling Heights, MI; Warren, MI; Troy, MI; Southfield, MI; Shelby Township, MI; Clinton Township, MI; Rochester, MI; Mount Clemens, MI…

National Provider Directory

National Provider Directory

Locations

15945 19 Mile Rd
Ste 202
Clinton Twp, MI 48038
Phone (586) 285-9270

13350 24 Mile Rd
Ste 800
Shelby Township, MI 48315
Phone (586) 722-7440

5335 Auburn Rd
Shelby Township, MI 48317
Phone (248) 212-0116

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1475798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551139200000",
    "number": "1003366675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33376 DEQUINDRE ROAD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483105966",
            "telephone_number": "586-722-7440",
            "fax_number": "586-722-7675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33376 DEQUINDRE ROAD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483105966",
            "telephone_number": "586-722-7440",
            "fax_number": "586-722-7675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K HEART & VASCULAR INSTITUTE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-07",
        "last_updated": "2019-02-26",
        "status": "A",
        "authorized_official_last_name": "KONERU",
        "authorized_official_first_name": "SRINIVAS",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "586-722-7440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF MICHIGAN",
            "identifier": "0501427",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF MICHIGAN",
            "identifier": "0E05972",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477599587",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sterling Heights, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.