Shanthi Gopal, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301083159 Issued in MI

Practice address

Henry Ford Health System
2799 West Grand Boulevard
Detroit, MI 48202

Phone

(313) 916-9106

Fax

(313) 916-1249

NPI assigned

Jan 19, 2007

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 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• State of Michigan Office of Financial Management

  dba Grand Rapids Home For Veterans

  • Nursing Facility/Intermediate Care Facility
  • Grand Rapids, MI
  • NPI 1710989298
  Medicare reassignment NPD
• State of Michigan Office of Financial Management

  dba Center for Forensic Psychiatry

  • Psychiatric Hospital
  • Saline, MI
  • NPI 1003859380
  NPD
• State of Michigan Office of Financial Management

  dba Michigan Veteran Homes at Chesterfield Twp

  • Skilled Nursing Facility
  • Chesterfield, MI
  • NPI 1497342653
  NPD

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205989753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HENRY FORD HEALTH SYSTEM",
            "address_2": "2799 WEST GRAND BOULEVARD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48202",
            "telephone_number": "313-916-9106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HENRY FORD HEALTH SYSTEM",
            "address_2": "2799 WEST GRAND BOULEVARD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48202",
            "telephone_number": "313-916-9106",
            "fax_number": "313-916-1249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOPAL",
        "first_name": "SHANTHI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301083159",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL-COMMERCIAL NUMBER",
            "identifier": "SG083159",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS-CHAMPUS",
            "identifier": "SG083159",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Geogette J Goodwin, RN
• Gerald Goodwin
• Meisha Renee Goodwin
• Juanita Gool, LLMSW
• Sherry Terease Goosby
• Pranav Gopalakrishnan
• Semira Vasanti Gopie, M.B.B.S.
• Sydney Lee Gordinier, FNP-C
• Carmetia Gordon, LPN
• Cole Joseph Gordon, MD

• Family Medicine Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.