Active NPI
Tammie Nallamothu, CRNA
- Certified Registered Nurse Anesthetist
- Royal Oak, MI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 4704219560
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 430F364420 | Other | MI | BCBSM |
| 4600772 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704219560 | MI | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| William Beaumont Hospital | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Motor City Anesthesia Services PLLC | Current | Accepting new patients | |
| Northstar Anesthesia of Michigan III PLLC | Nurse Anesthetist, Certified Registered | Current | 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.
-
- Anesthesiology Physician
- Dearborn, MI
- NPI 1457058125
-
- Hospitalist Physician
- Royal Oak, MI
- NPI 1811044878
Nurse Anesthetist, Certified Registered
-
- Pain Medicine (Anesthesiology) Physician
- Irving, TX
- NPI 1972126209
MI, Nurse Anesthetist, Certified Registered
-
- Anesthesiology Physician
- Grand Blanc, MI
- NPI 1235181223
Nurse Anesthetist, Certified Registered
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.