Active NPI
Kushaan Mehta
- Family Medicine Physician
- Grand Blanc, MI
National Provider Identifier
1205514528
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4351051203
- Practice address
- 1 Genesys Pkwy
Grand Blanc, MI 48439-8065 - Phone
- (810) 606-5000
- NPI assigned
- Jul 6, 2023
- Last updated
- Jul 8, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4351051203 | MI | Primary |
Addresses
Primary practice location
1 Genesys Pkwy
Grand Blanc, MI 48439-8065
Mailing address
1 Genesys Pkwy
Grand Blanc, MI 48439-8065
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230913001137 | KS | Order and Referring Only - Family Practice | 0446614275 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4351051203 | MI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1688601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688774400000",
"number": "1205514528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 GENESYS PKWY",
"city": "GRAND BLANC",
"state": "MI",
"postal_code": "484398065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 GENESYS PKWY",
"city": "GRAND BLANC",
"state": "MI",
"postal_code": "484398065",
"telephone_number": "810-606-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEHTA",
"first_name": "KUSHAAN",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-07-06",
"last_updated": "2023-07-08",
"certification_date": "2023-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4351051203",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Blanc, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.