Individual provider Active NPI

Carrie Lynn Selvaraj, MD

  • Cardiovascular Disease Physician
  • Saginaw, MI
National Provider Identifier
1265407647
Registry record updated Jun 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
M9643 Issued in TX
Practice address
1015 S Washington Ave
Saginaw, MI 48601-2556
Phone
(989) 754-3349
Fax
(989) 755-1365
NPI assigned
Feb 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2011

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 35081968 OH
Cardiovascular Disease Physician 207RC0000X M9643 TX Primary
Cardiovascular Disease Physician 207RC0000X 4301098713 MI

Addresses

Primary practice location

1015 S Washington Ave
Saginaw, MI 48601-2556

Mailing address

1015 S Washington Ave
Saginaw, MI 48601-2556
Phone (989) 754-3349

Other identifiers 1

IdentifierTypeStateIssuer
194328403MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301098713MIMDCardiovascular Disease Physician
35081968OHMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Careline Hmi300 LLC CurrentSince Jul 20, 2022 Accepting new patients
Premier Heart Associates, Inc Cardiovascular Disease Past Accepting new patients
Mymichigan Medical Center Saginaw PastSince Oct 1, 2011 Accepting new patients

Locations

770 Kenmoor Ave SE
Ste 100
Grand Rapids, MI 49546
Phone (616) 272-3533

801 Rosehill Rd
Jackson, MI 49202
Phone (517) 212-2008

Organizations & group practices 3

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": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306972800000",
    "number": "1265407647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 S WASHINGTON AVE",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486012556",
            "telephone_number": "989-754-3349",
            "fax_number": "989-755-1365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 S WASHINGTON AVE",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486012556",
            "telephone_number": "989-754-3349",
            "fax_number": "989-755-1365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELVARAJ",
        "first_name": "CARRIE",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-21",
        "last_updated": "2011-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OH",
            "license": "35081968",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TX",
            "license": "M9643",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": "4301098713",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "194328403",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saginaw, MI

Sources for this page

Verify at the official NPI Registry.