NPIMap

Individual provider Active NPI

Pavan Chanamolu

  • Student in an Organized Health Care Education/Training Program
  • Mt Pleasant, MI
National Provider Identifier
1194321901
Registry record updated Dec 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1280 E Campus Dr
Mount Pleasant, MI 48859-4484
Phone
(989) 774-2478
NPI assigned
Dec 7, 2020
Last updated
Dec 7, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1280 E Campus Dr
Mount Pleasant, MI 48859-4484

Mailing address

1730 Somerset Dr
Mount Pleasant, MI 48858-4484

Other practice location 1

1730 Somerset Dr
Mount Pleasant, MI 48858-4484
Phone (248) 633-6054

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
I20211025001081 MI Practitioner - Physician Assistant 9133517121 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mymichigan Medical Center MidlandGroup PAC ID 2264323633, 507 clinicians

Practice addresses (Care Compare)

4000 Wellness Dr
Midland, MI 48670-2000
Phone (989) 633-8018

4500 Campus Ridge Dr
Midland, MI 48640-6123
Phone (989) 837-9250

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mymichigan Medical Center Midland CurrentSince Oct 22, 2021 Accepting new patients
Mymichigan Medical Center Midland CurrentSince Oct 22, 2021 Accepting new patients

Locations

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

4500 N Campus Ridge Dr
Midland, MI 48640
Phone (989) 837-9250

2660 W Sugnet Rd
Midland, MI 48640
Phone (989) 488-5010

Interoperability endpoints

  • Direct secure messaging: pchanamolu97723@mymichiganhealth.midirect.net

Organizations & group practices 2

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 8

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": "1607299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607299200000",
    "number": "1194321901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1730 SOMERSET DR",
            "city": "MOUNT PLEASANT",
            "state": "MI",
            "postal_code": "488584484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1280 E CAMPUS DR",
            "city": "MOUNT PLEASANT",
            "state": "MI",
            "postal_code": "488594484",
            "telephone_number": "989-774-2478"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1730 Somerset Dr",
            "address_purpose": "LOCATION",
            "city": "Mount Pleasant",
            "state": "MI",
            "postal_code": "488584484",
            "country_code": "US",
            "telephone_number": "248-633-6054",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHANAMOLU",
        "first_name": "PAVAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-07",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt Pleasant, MI

Sources for this page

Verify at the official NPI Registry.