NPIMap

Individual provider Active NPI

Shukri Wadi David, MD

  • Interventional Cardiology Physician
  • Southfield, MI
National Provider Identifier
1255315347
Registry record updated Jan 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
4301048135 Issued in MI
Practice address
22250 Providence Dr
Ste # 705
Southfield, MI 48075-4825
Phone
(248) 552-9858
Fax
(248) 552-9510
NPI assigned
Dec 1, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 4301048135 MI
Cardiovascular Disease Physician 207RC0000X 35057974 OH
Interventional Cardiology Physician 207RI0011X 4301048135 MI Primary

Addresses

Primary practice location

22250 Providence Dr
Ste # 705
Southfield, MI 48075-4825

Mailing address

22250 Providence Dr
Ste # 705
Southfield, MI 48075-4825
Phone (248) 552-9858

Other identifiers 1

IdentifierTypeStateIssuer
2640732MedicaidMI

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
I20040414001163 MI Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 5092708651 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Health Providence HospitalGroup PAC ID 6103738703, 364 clinicians

Practice addresses (Care Compare)

16001 W 9 Mile Rd
Southfield, MI 48075-4818
Phone (248) 424-3000

Hospital & facility affiliations

  • Ascension Providence Hospital, Southfield and Novi Hospital, Southfield, MI, CCN 230019
  • Henry Ford Health St John Hospital Hospital, Detroit, MI, CCN 230165
  • Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053
  • Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130
  • St Joe Mercy Hospital System Livonia Hospital, Livonia, MI, CCN 230002

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as apm

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35057974OHMDCardiovascular Disease Physician
4301048135MIMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health Providence Hospital Current Accepting new patients
Henry Ford Health Providence Hospital Current Accepting new patients
Henry Ford Health Providence Hospital CurrentSince May 1, 2017 Accepting new patients
Henry Ford Health Providence Hospital Cardiovascular Disease CurrentSince May 1, 2017 Accepting new patients
Henry Ford Health Providence Hospital Past Accepting new patients

Locations

1225 S Latson Rd
Ste 230
Howell, MI 48843
Phone (517) 548-7777

47601 Grand River Ave
Ste C202
Novi, MI 48374
Phone (248) 465-4163

26850 Providence Pkwy
Ste 205
Novi, MI 48374
Phone (248) 465-3144

22250 Providence Dr
Ste 705
Southfield, MI 48075
Phone (248) 465-5955

16001 W 9 Mile Rd
Southfield, MI 48075
Phone (248) 424-3000

Interoperability endpoints

  • Direct secure messaging: sdavid1124569@direct.hfhs.org
  • Direct secure messaging: dr_david@heartcardiologyconsultants.ssdirect.aprima.com

Organizations & group practices 5

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.

Hospital & facility affiliations 7

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": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389571200000",
    "number": "1255315347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22250 PROVIDENCE DR",
            "address_2": "STE # 705",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754825",
            "telephone_number": "248-552-9858",
            "fax_number": "248-552-9510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22250 PROVIDENCE DR",
            "address_2": "STE # 705",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754825",
            "telephone_number": "248-552-9858",
            "fax_number": "248-552-9510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVID",
        "first_name": "SHUKRI",
        "middle_name": "WADI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2014-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": "4301048135",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OH",
            "license": "35057974",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MI",
            "license": "4301048135",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2640732",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.