Individual provider Active NPI

Tammie Nallamothu, CRNA

  • Certified Registered Nurse Anesthetist
  • Royal Oak, MI
National Provider Identifier
1063480259
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704219560 Issued in MI
Practice address
3601 W. 13 Mile Rd
400 FSC-PCS
Royal Oak, MI 48073-6769
Phone
(248) 423-2481
NPI assigned
Mar 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 4704219560 MI Primary

Addresses

Primary practice location

3601 W. 13 Mile Rd
400 FSC-PCS
Royal Oak, MI 48073-6769

Mailing address

3601 W. 13 Mile Rd
400 FSC-PCS
Royal Oak, MI 48073-6769
Phone (248) 423-2481

Other identifiers 2

IdentifierTypeStateIssuer
430F364420OtherMIBCBSM
4600772MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040618000141 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 6305820085 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4704219560MIMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
William Beaumont Hospital Nurse Anesthetist, Certified Registered Current Accepting new patients
Motor City Anesthesia Services PLLC CurrentSince Sep 6, 2024 Accepting new patients
Northstar Anesthesia of Michigan III PLLC Nurse Anesthetist, Certified Registered CurrentSince Mar 19, 2021 Accepting new patients
American Anesthesiology Associates of Michigan, PC Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

18100 Oakwood Blvd
Ste 100
Dearborn, MI 48124
Phone (313) 240-7668

3601 W 13 Mile Rd
#400
Royal Oak, MI 48073
Phone (248) 423-2481

3601 W 13 Mile Rd
Royal Oak, MI 48073

33155 Annapolis St
Wayne, MI 48184
Phone (734) 467-4042

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1063480259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 W. 13 MILE RD",
            "address_2": "400 FSC-PCS",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736769",
            "telephone_number": "248-423-2481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 W. 13 MILE RD",
            "address_2": "400 FSC-PCS",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736769",
            "telephone_number": "248-423-2481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NALLAMOTHU",
        "first_name": "TAMMIE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-14",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704219560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "430F364420",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4600772",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Royal Oak, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2024; 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.