Preeti Gautam Misra, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301085344 Issued in MI

Practice address

5301 E Huron River Dr
Ypsilanti, MI 48197-1051

Phone

(734) 712-8676

Fax

(734) 712-3855

NPI assigned

Feb 3, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

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

Specialty

Internal MedicineAlso: Hospitalist

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Iha Olma Primary Care Risk LLCGroup PAC ID 1153733324, 26 clinicians

Iha Health Services CorporationGroup PAC ID 2466351440, 1,149 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Joe Mercy Hospital System Livonia Hospital, Livonia, MI, CCN 230002
• University of Michigan Health System Hospital, Ann Arbor, MI, CCN 230046

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pmisra32526@direct.trinity-health.org

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.

• Iha Health Services Corporation

  • Obstetrics & Gynecology Physician
  • Canton, MI
  • NPI 1457408965
  Medicare reassignment Care Compare group NPD
• Iha Olma Primary Care Risk LLC

  • Internal Medicine Physician
  • Livonia, MI
  • NPI 1578162319
  Medicare reassignment Care Compare group NPD
• St Mary Mercy Hospital Professional

  • General Acute Care Hospital
  • Livonia, MI
  • NPI 1528145554
  Medicare reassignment NPD
• Iha Health Service Corporation

  • Obstetrics & Gynecology Physician
  • Ypsilanti, MI
  • NPI 1831053701
  NPD
• Iha Health Services Corporation

  • Hospitalist Physician
  • Ypsilanti, MI
  • NPI 1306121405
  NPD
• Iha Olma Primary Care Risk LLC

  • Primary Care Clinic/Center
  • Livonia, MI
  • NPI 1255802559

  Internal Medicine

  NPD
• St Mary Mercy Hospital Crna

  • Certified Registered Nurse Anesthetist
  • Livonia, MI
  • NPI 1063602092
  NPD
• St Mary Mercy Hospital Professional

  • Community/Behavioral Health Agency
  • Ann Arbor, MI
  • NPI 1386913705
  NPD
• St Mary Mercy Hospital Professional

  • Gastroenterology Physician
  • Ypsilanti, MI
  • NPI 1447953971
  NPD
• St Mary Mercy Hospital

  • General Acute Care Hospital
  • Livonia, MI
  • NPI 1790706901
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Regents of the University of Michigan

  • General Acute Care Hospital
  • Ann Arbor, MI
  • NPI 1003878539
  Care Compare affiliation
• St Mary Mercy Hospital

  • General Acute Care Hospital
  • Livonia, MI
  • NPI 1790706901
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601424000000",
    "number": "1174701049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 FRANK LLOYD WRIGHT DR LBBY J2000",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481059484",
            "telephone_number": "734-747-6766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 E HURON RIVER DR",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971051",
            "telephone_number": "734-712-8676",
            "fax_number": "734-712-3855"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "28411 Northwestern Hwy",
            "address_2": "Suite 1050",
            "address_purpose": "LOCATION",
            "city": "Southfield",
            "state": "MI",
            "postal_code": "480345544",
            "country_code": "US",
            "telephone_number": "248-354-4709",
            "fax_number": "248-354-4807",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MISRA",
        "first_name": "PREETI",
        "middle_name": "GAUTAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-03",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301085344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY",
            "identifier": "207R00000X",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "110F336360",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1346398971",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105344514",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PM085344",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Liliya Mironova, LMSW
• Grace Ogle Mishkin, CFNP, CNM
• Elizabeth R Mishler
• Roy Misirliyan, MD
• Rachel Kyley Misola, PA-C
• Mission Assessments & Personalized Services, LLC
• Mitchell Home Medical, Inc.
• Candice Mitchell
• Holly Ann Mitchell, RN
• Kayla Mitchell

• Internal Medicine Physician in Ypsilanti, MI
• Providers in Ypsilanti, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.