Vijaya Mamidipaka, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301082641 Issued in MI

Practice address

47500 Ffve Mile Road
Plymouth, MI 48170

Phone

(734) 459-7400

Fax

(734) 459-7403

NPI assigned

Jun 20, 2006

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 1

Other names 1

• Dr. Vijaya Kalluri Former name

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

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 and National Provider Directory roles.

• State of Michigan Office of Financial Management

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

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

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

  • Community Health Clinic/Center
  • Plymouth, MI
  • NPI 1992728331
  NPD (past)

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240963200000",
    "number": "1295770394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47500 FIVE MILE RD",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481702487",
            "telephone_number": "734-459-7400",
            "fax_number": "734-459-7403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47500 FFVE MILE ROAD",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "48170",
            "telephone_number": "734-459-7400",
            "fax_number": "734-459-7403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMIDIPAKA",
        "first_name": "VIJAYA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-20",
        "last_updated": "2009-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301082641",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MI",
            "identifier": "OH24978",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VIJAYA",
            "last_name": "KALLURI",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tayler Malinowski
• Sravanthi Mallahm
• Naumaan Mallhi, D.O.
• Cashmire Malone
• Allyson Malong
• Archana Mandhare, NP
• Jaimie Lynn Manfre, CCC-SLP
• Mangin Psychological Services, LLC
• Stephen Mangin, MS, LLP
• Allison Mann

• Family Medicine Physician in Plymouth, MI
• Providers in Plymouth, 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 Apr 29, 2009; 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.