Individual provider Active NPI

Andrea Olivarez Sevanthinathan, CNP

  • Nurse Practitioner
  • Detroit, MI
National Provider Identifier
1083968432
Registry record updated Nov 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704271314 Issued in MI
Practice address
4100 John R
Karmanos Cancer Center
Detroit, MI 48201-2013
Phone
(800) 527-6266
Fax
(313) 576-8381
NPI assigned
Nov 7, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704271314 MI
Nurse Practitioner 363L00000X 4704271314 MI Primary

Addresses

Primary practice location

4100 John R
Karmanos Cancer Center
Detroit, MI 48201-2013

Mailing address

1560 E. Maple Rd
Suite 400-Credentialing
Troy, MI 48083-1138
Phone (800) 527-6266

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130402000298 MI Practitioner - Nurse Practitioner 2769627322 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Physician GroupGroup PAC ID 8628087681, 399 clinicians

Practice addresses (Care Compare)

4100 John R St
Detroit, MI 48201-2013
Phone (800) 527-6266

Hospital & facility affiliations

  • Karmanos Cancer Center Hospital, Detroit, MI, CCN 230297

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704271314MIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Barbara Ann Karmanos Cancer Institute CurrentSince Jan 1, 2025 Accepting new patients
Barbara Ann Karmanos Cancer Institute CurrentSince Jan 1, 2025 Accepting new patients
University Physician Group Past Accepting new patients

Locations

4100 John R St
Detroit, MI 48201
Phone (313) 576-8530

31995 Northwestern Hwy
Farmington Hills, MI 48334
Phone (248) 538-4701

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.

Hospital & facility affiliations 1

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": "1352246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477958400000",
    "number": "1083968432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 E. MAPLE RD",
            "address_2": "SUITE 400-CREDENTIALING",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831138",
            "telephone_number": "800-527-6266",
            "fax_number": "313-576-8381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 JOHN R",
            "address_2": "KARMANOS CANCER CENTER",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012013",
            "telephone_number": "800-527-6266",
            "fax_number": "313-576-8381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEVANTHINATHAN",
        "first_name": "ANDREA",
        "middle_name": "OLIVAREZ",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-07",
        "last_updated": "2016-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704271314",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704271314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.