NPIMap

Individual provider Active NPI

Deepanvita Kalvala, MD

  • Family Medicine Physician
  • Toledo, OH
National Provider Identifier
1124589239
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301509743 Issued in MI
Practice address
3333 Glendale Ave
Toledo, OH 43614-2426
Phone
(419) 383-5502
Fax
(419) 383-5515
NPI assigned
Mar 29, 2019
Last updated
Aug 21, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2023

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
Family Medicine Physician 207Q00000X 4301509743 MI Primary

Addresses

Primary practice location

3333 Glendale Ave
Toledo, OH 43614-2426

Mailing address

3333 Glendale Ave
Toledo, OH 43614-2426
Phone (419) 383-5502

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
I20230825000619 MI Practitioner - Family Practice 2062740657 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promedica Monroe PhysiciansGroup PAC ID 2365696176, 64 clinicians

Practice addresses (Care Compare)

6650 Stewart Rd
Monroe, MI 48162-9680
Phone (734) 240-8430

718 N Macomb St
Monroe, MI 48162-7815
Phone (734) 240-8987

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301509743MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Memorial Hospital Corporation CurrentSince Aug 1, 2023 Accepting new patients
Mercy Memorial Hospital Corporatio CurrentSince Aug 1, 2023 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Monroe Opco LLC Past Accepting new patients

Locations

650 Stewart Rd
Monroe, MI 48162
Phone (734) 240-4594

718 N Macomb St
Monroe, MI 48162
Phone (734) 212-3097

905 N Macomb St
Ste 2
Monroe, MI 48162
Phone (734) 242-1899

2142 N Cove Blvd
Toledo, OH 43606
Phone (419) 291-1111

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1553817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692576000000",
    "number": "1124589239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 GLENDALE AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436142426",
            "telephone_number": "419-383-5502",
            "fax_number": "419-383-5515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 GLENDALE AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436142426",
            "telephone_number": "419-383-5502",
            "fax_number": "419-383-5515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALVALA",
        "first_name": "DEEPANVITA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-29",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301509743",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.