NPIMap

Individual provider Active NPI

Kenneth J Bottesi, MD

  • Neurology Physician
  • Shelby Township, MI
National Provider Identifier
1164419008
Registry record updated Mar 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
4301059564 Issued in MI
Practice address
45634 Schoenherr Rd
Shelby Township, MI 48315-6024
Phone
(586) 566-3000
Fax
(586) 566-3070
NPI assigned
Oct 5, 2005
Last updated
Mar 9, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 4301059564 MI Primary

Addresses

Primary practice location

45634 Schoenherr Rd
Shelby Township, MI 48315-6024

Mailing address

45634 Schoenherr Rd
Shelby Township, MI 48315-6024
Phone (586) 566-3000

Other identifiers 3

IdentifierTypeStateIssuer
4910926MedicaidMI
4910630MedicaidMI
4592447MedicaidMI

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
I20050715000937 MI Practitioner - Neurology 0840226254 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Wayne State University School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Semi Medical GroupGroup PAC ID 0648180406, 246 clinicians

Practice addresses (Care Compare)

45634 Schoenherr Rd
Shelby Township, MI 48315-6024
Phone (586) 566-3000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as apm

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301059564MIMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Semi Medical Group CurrentSince Mar 1, 2001 Accepting new patients
Henry Ford Semi Medical Group CurrentSince Mar 1, 2001 Accepting new patients
Henry Ford Semi Medical Group Neurology Current Accepting new patients
Ascension Macomb Oakland Hospital Past Accepting new patients
Henry Ford Health Macomb-Oakland Hospital Past Accepting new patients
Podcare PC Past Accepting new patients

Locations

7733 E Jefferson Ave
Detroit, MI 48214
Phone (313) 499-3000

37771 Schoenherr Rd
Ste 104
Sterling Hts, MI 48312
Phone (810) 286-0050

45634 Schoenherr Rd
Utica, MI 48315
Phone (586) 532-8440

11012 E 13 Mile Rd
Warren, MI 48093
Phone (586) 573-8890

27450 Schoenherr Rd
Warren, MI 48088
Phone (313) 499-4800

28000 Dequindre Rd
Warren, MI 48092
Phone (586) 743-0944

30117 Schoenherr Rd
Ste 400
Warren, MI 48088
Phone (586) 552-4848

Organizations & group practices 6

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 6

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": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236556800000",
    "number": "1164419008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45634 SCHOENHERR RD",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483156024",
            "telephone_number": "586-566-3000",
            "fax_number": "586-566-3070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45634 SCHOENHERR RD",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483156024",
            "telephone_number": "586-566-3000",
            "fax_number": "586-566-3070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTTESI",
        "first_name": "KENNETH",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-05",
        "last_updated": "2009-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301059564",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4910926",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4910630",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4592447",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby Township, MI

Sources for this page

Verify at the official NPI Registry.