NPIMap

Individual provider Active NPI

Vamshidhar Guduguntla, MD

  • Cardiovascular Disease Physician
  • Roseville, MI
National Provider Identifier
1174525729
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
4301063528 Issued in MI
Practice address
25195 Kelly Rd
Suite a
Roseville, MI 48066-4909
Phone
(586) 775-4594
Fax
(586) 775-4506
NPI assigned
Aug 12, 2005
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 4301063528 MI Primary
Interventional Cardiology Physician 207RI0011X 4301063528 MI

Addresses

Primary practice location

25195 Kelly Rd
Suite a
Roseville, MI 48066-4909

Mailing address

25195 Kelly Rd
Suite a
Roseville, MI 48066-4909
Phone (586) 775-4594

Other identifiers 3

IdentifierTypeStateIssuer
060-501-2281OtherMIBLUE CROSS BLUE SHIELD
4472707MedicaidMI
OH-26467013OtherMIMEDICARE ID

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
I20080414000078 MI Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Other (Physician) 2567549660 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

11800 E 12 Mile Rd
Warren, MI 48093-3472
Phone (586) 573-5000

17900 23 Mile Rd
Macomb, MI 48044-1161

22101 Moross Rd
Detroit, MI 48236-2148
Phone (586) 753-0011

25195 Kelly Rd
Suite a
Roseville, MI 48066-5084
Phone (586) 775-4594

27351 Dequindre Rd
Madison Heights, MI 48071-3487
Phone (248) 967-7000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301063528MIMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health St. John Hospital CurrentSince Feb 6, 2010 Accepting new patients
Henry Ford Health St. John Hospital Current Accepting new patients
Henry Ford Semi Medical Group CurrentSince Jun 6, 2017 Accepting new patients
Henry Ford Health St. John Hospital CurrentSince Feb 6, 2010 Accepting new patients
Henry Ford Semi Medical Group Cardiovascular Disease CurrentSince Jun 6, 2017 Accepting new patients
Center for Preventive Medicine PC CurrentSince Aug 22, 2009 Accepting new patients
Eastside Cardiovascular Medicine Interventional Cardiology Current Accepting new patients
Henry Ford Health St. John Hospital Current Accepting new patients
Henry Ford Semi Medical Group Current Accepting new patients

Locations

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

20870 Mack Ave
Grosse Pointe Woods, MI 48236
Phone (313) 885-2334

25195 Kelly Rd
Ste A
Roseville, MI 48066
Phone (586) 775-4594

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

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

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

Interoperability endpoints

  • Direct secure messaging: vamshidhar.guduguntla.1@8209.direct.athenahealth.com

Organizations & group practices 11

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": "1123804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1174525729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25195 KELLY RD",
            "address_2": "SUITE A",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664909",
            "telephone_number": "586-775-4594",
            "fax_number": "586-775-4506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25195 KELLY RD",
            "address_2": "SUITE A",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664909",
            "telephone_number": "586-775-4594",
            "fax_number": "586-775-4506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUDUGUNTLA",
        "first_name": "VAMSHIDHAR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-12",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": "4301063528",
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MI",
            "license": "4301063528",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "060-501-2281",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4472707",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "OH-26467013",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MI

Sources for this page

Verify at the official NPI Registry.