Individual provider Active NPI

Kristy Prakash Patel

  • Neonatal-Perinatal Medicine Physician
  • Detroit, MI
National Provider Identifier
1184243644
Registry record updated Jul 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
4301509557 Issued in MI
Practice address
3901 Beaubien St
Detroit, MI 48201-2119
Phone
(313) 745-7496
Fax
(313) 993-7118
NPI assigned
Apr 14, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 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
Neonatal-Perinatal Medicine Physician 2080N0001X 4301509557 MI Primary

Addresses

Primary practice location

3901 Beaubien St
Detroit, MI 48201-2119

Mailing address

3901 Beaubien St
Detroit, MI 48201-2196
Phone (313) 745-7496

Other practice location 1

2500 N State St
Jackson, MS 39216-4500
Phone (601) 984-6562

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20201218001229 MS Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 5294147021

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Other, 2020
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1 Ford PL
Detroit, MI 48202-3067

1 Ford PL
3A
Detroit, MI 48202-3450

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4301509557MIMDNeonatal-Perinatal Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1586822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688774400000",
    "number": "1184243644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 BEAUBIEN ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012196",
            "telephone_number": "313-745-7496",
            "fax_number": "313-993-7118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 BEAUBIEN ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012119",
            "telephone_number": "313-745-7496",
            "fax_number": "313-993-7118"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 N State St",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164500",
            "country_code": "US",
            "telephone_number": "601-984-6562",
            "fax_number": "601-918-2086",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATEL",
        "first_name": "KRISTY",
        "middle_name": "PRAKASH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-14",
        "last_updated": "2023-07-08",
        "certification_date": "2023-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "MI",
            "license": "4301509557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.