Active NPI
Sudarshan R Reddy, M.D.
- Plastic Surgery Physician
- Clinton TWP, MI
National Provider Identifier
1073597217
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- 4301039506
- Practice address
- 43281 Commons
Clinton TWP, MI 48038 - Phone
- (586) 263-6050
- Fax
- (586) 263-0436
- NPI assigned
- Dec 1, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 4301039506 | MI | Primary |
Addresses
Primary practice location
43281 Commons
Clinton TWP, MI 48038
Mailing address
43281 Commons
Clinton TWP, MI 48038
Phone (586) 263-6050
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1572763024 | Medicaid | MI | |
| A73212 | Other | MI | HAP |
| 15726310 | Medicaid | MI | |
| 2405003712 | Other | MI | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301039506 | MI | MD | Plastic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Plastic Surgery Center Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Ambulatory Surgical Clinic/Center
- Clinton Township, MI
- NPI 1902887300
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426809600000",
"number": "1073597217",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43281 COMMONS",
"city": "CLINTON TWP",
"state": "MI",
"postal_code": "48038",
"telephone_number": "586-263-6050",
"fax_number": "586-263-0436"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "43281 COMMONS",
"city": "CLINTON TWP",
"state": "MI",
"postal_code": "48038",
"telephone_number": "586-263-6050",
"fax_number": "586-263-0436"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REDDY",
"first_name": "SUDARSHAN",
"middle_name": "R",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-01",
"last_updated": "2015-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "MI",
"license": "4301039506",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1572763024",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HAP",
"identifier": "A73212",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "15726310",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "2405003712",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clinton TWP, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.