Individual provider Active NPI

Sriram Srinivasan, PT

  • Physical Therapist
  • Sterling Heights, MI
National Provider Identifier
1205026879
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501005297 Issued in MI
Practice address
43154 Dequindre Rd
Sterling Heights, MI 48314-1723
Phone
(586) 991-0430
Fax
(586) 991-0435
NPI assigned
Jul 30, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501005297 MI Primary

Addresses

Primary practice location

43154 Dequindre Rd
Sterling Heights, MI 48314-1723

Mailing address

43154 Dequindre Rd
Sterling Heights, MI 48314-1723
Phone (586) 991-0430

Other identifiers 1

IdentifierTypeStateIssuer
650E016550OtherMIBCBSM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041209000751 MI Practitioner - Physical Therapist in Private Practice 8527024868 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

43154 Dequindre Rd
Sterling Heights, MI 48314-1723
Phone (586) 991-0430

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5501005297MIMDPhysical Therapist

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1185753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746576000000",
    "number": "1205026879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43154 DEQUINDRE RD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483141723",
            "telephone_number": "586-991-0430",
            "fax_number": "586-991-0435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43154 DEQUINDRE RD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483141723",
            "telephone_number": "586-991-0430",
            "fax_number": "586-991-0435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SRINIVASAN",
        "first_name": "SRIRAM",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-30",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501005297",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "650E016550",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sterling Heights, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.