Active NPI
Bharathi Gorantla, MDS
- Dentist
- Saginaw, MI
National Provider Identifier
1285058420
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901022323
- Practice address
- 3890 Dixie Hwy # 1a
Saginaw, MI 48601-4205 - Phone
- (989) 777-4880
- NPI assigned
- Feb 7, 2014
- Last updated
- Jul 21, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 2901022323 | MI | Primary |
Addresses
Primary practice location
3890 Dixie Hwy # 1a
Saginaw, MI 48601-4205
Mailing address
3890 Dixie Hwy #1a
Saginaw, MI 48601
Phone (989) 777-4880
Other practice location 1
625 Elmwood Ave # 683
Rochester, NY 14620-2913
Phone (585) 275-5051
Medicare participation
Medicare enrollment files- 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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170721001897 | MI | Order and Referring Only - Dentist | 5799055851 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901022323 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1391731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1285058420",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3890 DIXIE HWY #1A",
"city": "SAGINAW",
"state": "MI",
"postal_code": "48601",
"telephone_number": "989-777-4880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3890 DIXIE HWY # 1A",
"city": "SAGINAW",
"state": "MI",
"postal_code": "486014205",
"telephone_number": "989-777-4880"
}
],
"practiceLocations": [
{
"address_1": "625 Elmwood Ave # 683",
"address_purpose": "LOCATION",
"city": "Rochester",
"state": "NY",
"postal_code": "146202913",
"country_code": "US",
"telephone_number": "585-275-5051",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GORANTLA",
"first_name": "BHARATHI",
"credential": "MDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-02-07",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901022323",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saginaw, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.