Individual provider Active NPI

Balajee Goutam Nallamothu, M.D.

  • Anesthesiology Physician
  • Royal Oak, MI
National Provider Identifier
1104863414
Registry record updated Aug 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
4301061524 Issued in MI
Practice address
3601 W 13 Mile Rd
Royal Oak, MI 48073-6712
Phone
(248) 898-1905
Fax
(248) 898-1032
NPI assigned
Jun 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 4301061524 MI Primary

Addresses

Primary practice location

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712

Mailing address

1631 W Big Beaver Rd
Troy, MI 48084-3501
Phone (248) 458-0400

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031211000791 MI Practitioner - AnesthesiologyPractitioner - Critical Care (Intensivists) 4082510714 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Critical Care (Intensivists)
Education
Wayne State University School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Motor City Anesthesia Services PLLCGroup PAC ID 3173962800, 2 clinicians

Practice addresses (Care Compare)

18100 Oakwood Blvd
Suite 100
Dearborn, MI 48124-4085
Phone (734) 212-3097

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301061524MIMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Long Lake Anesthesiology Consultants, PLC Anesthesiology CurrentSince May 1, 2015 Accepting new patients
Waterford Anesthesia, PLLC Anesthesiology CurrentSince Aug 16, 2015 Accepting new patients
Motor City Anesthesia Services PLLC Anesthesiology CurrentSince Dec 1, 2021 Accepting new patients
Apex Anesthesia Services PLLC Past Accepting new patients
United Pain Therapies PLLC Anesthesiology Past Accepting new patients
Waterford Surgical Center, LLC Past Accepting new patients
Bloomfield Anesthesia, PC Anesthesiology Past Accepting new patients

Locations

2009 Momentum Pl
Chicago, IL 60689

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

1546 Callis Rd
Lapeer, MI 48446
Phone (810) 667-4000

920 River Centre Dr
Port Huron, MI 48060
Phone (810) 984-5200

4550 Investment Dr
Ste 100
Troy, MI 48098
Phone (248) 265-4600

5220 Highland Rd
Ste 100
Waterford, MI 48327
Phone (248) 461-2800

5220 Highland Rd
Ste 1
Waterford, MI 48327
Phone (248) 886-5555

Organizations & group practices 7

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": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187308800000",
    "number": "1104863414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1631 W BIG BEAVER RD",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480843501",
            "telephone_number": "248-458-0400",
            "fax_number": "248-458-0310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 W 13 MILE RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736712",
            "telephone_number": "248-898-1905",
            "fax_number": "248-898-1032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NALLAMOTHU",
        "first_name": "BALAJEE",
        "middle_name": "GOUTAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-02",
        "last_updated": "2007-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "4301061524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Royal Oak, MI

Sources for this page

Verify at the official NPI Registry.