NPIMap

Individual provider Active NPI

Shashank Vodapally, DO

  • Physical Medicine & Rehabilitation Physician
  • Grand Rapids, MI
National Provider Identifier
1063975647
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
5101027901 Issued in MI
Practice address
245 Cherry St SE Ste 300
Grand Rapids, MI 49503-4607
Phone
(616) 685-5050
NPI assigned
Apr 10, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physical Medicine & Rehabilitation Physician 208100000X 5101027901 MI Primary

Addresses

Primary practice location

245 Cherry St SE Ste 300
Grand Rapids, MI 49503-4607

Mailing address

35 Summer Hill CT
Cheshire, CT 06410-1361
Phone (203) 631-1104

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240515003826 MI Practitioner - Pain Management 3779924105 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pain Management
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Advantage Health/Saint Mary'S Medical GroupGroup PAC ID 4082807961, 499 clinicians

Practice addresses (Care Compare)

245 Cherry St SE
Suite 300
Grand Rapids, MI 49503-4607
Phone (616) 685-5050

Hospital & facility affiliations

  • Trinity Health at Home - Grand Rapids Home health agency, Grand Rapids, MI, CCN 237217
  • Mercy Health Saint Mary'S Hospital, Grand Rapids, MI, CCN 230059
  • Spectrum Health Hospital, Grand Rapids, MI, CCN 230038
  • Mary Free Bed Rehabilitation Hospital Inpatient rehabilitation facility, Grand Rapids, MI, CCN 233026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health/Saint Mary'S Medical Group Current Accepting new patients
Advantage Health Saint Mary'S Medical Group CurrentSince Jul 1, 2024 Accepting new patients
Advantage Health Saint Mary'S Medical Group CurrentSince Jul 1, 2024 Accepting new patients

Locations

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

245 Cherry St SE
Ste 300
Grand Rapids, MI 49503
Phone (616) 285-1377

Interoperability endpoints

  • Direct secure messaging: svodapally3439444@direct.trinity-health.org

Organizations & group practices 3

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1554854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1063975647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 SUMMER HILL CT",
            "city": "CHESHIRE",
            "state": "CT",
            "postal_code": "064101361",
            "telephone_number": "203-631-1104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 CHERRY ST SE STE 300",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034607",
            "telephone_number": "616-685-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VODAPALLY",
        "first_name": "SHASHANK",
        "name_prefix": "Mr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-10",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "5101027901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.