Shamoli Khanderia, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5101018559 Issued in MI

Practice address

207 Fletcher St
Ann Arbor, MI 48109-1050

Phone

(734) 764-8320

Fax

(734) 763-7505

NPI assigned

Apr 28, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Regents of the University of Michigan-Uhs-University Health SerGroup PAC ID 2567369515, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Regents of the University of Michigan-Uhs-University Health Ser

  • Internal Medicine Physician
  • Ann Arbor, MI
  • NPI 1265610570
  Medicare reassignment Care Compare group NPD
• Adventist Health Partners, Inc

  dba Hinsdale Primary Care

  • Family Medicine Physician
  • Hinsdale, IL
  • NPI 1952339939
  NPD (past)
• Adventist Health Partners,Inc

  dba Glendale Family Practice

  • Family Medicine Physician
  • Bloomingdale, IL
  • NPI 1043255888
  NPD (past)

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354579200000",
    "number": "1043277395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 FLETCHER ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481091050",
            "telephone_number": "734-764-8320",
            "fax_number": "734-763-7505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 FLETCHER ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481091050",
            "telephone_number": "734-764-8320",
            "fax_number": "734-763-7505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHANDERIA",
        "first_name": "SHAMOLI",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-28",
        "last_updated": "2012-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101018559",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200871670",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE - RAILROAD",
            "identifier": "P00471980",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarina Khan, DO
• Shihan Naeem Khan, MD
• Syma Khan, MSW
• Taha Khan
• Zarrish Saeed Khan, MD
• Ritika Khandpur, M.D.
• Erin Khang, LMSW
• Aishwarya Khanna
• Dinesh Khanna, M.D.
• Neil Kumar Khanna, M.D.

• Family Medicine Physician in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.