Active NPI
Amanda Su
- Gastroenterology Physician
- Detroit, MI
National Provider Identifier
1306334131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 4301511164
- Practice address
- 2799 W Grand Blvd
Detroit, MI 48202-2608 - Phone
- (313) 916-8632
- NPI assigned
- Apr 26, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Gastroenterology Physician | 207RG0100X | 4301511164 | MI | Primary |
| Internal Medicine Physician | 207R00000X | 4301511164 | MI |
Addresses
Primary practice location
2799 W Grand Blvd
Detroit, MI 48202-2608
Mailing address
1 Ford PL Ste 3a
Detroit, MI 48202-3450
Phone (313) 874-2892
Other practice location 1
1800 Orleans St
Baltimore, MD 21287-0010
Phone (410) 955-5000
Other practice location 2
205 N East Ave Fl 5
Jackson, MI 49201-1753
Phone (517) 205-7618
Other practice location 3
6777 W Maple Rd
West Bloomfield, MI 48322-3013
Phone (800) 653-6568
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: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240723000617 | MI | Practitioner - Gastroenterology | 8123370392 | Reassigns benefits to 2 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Gastroenterology
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Henry Ford Health System
Practice addresses (Care Compare)
2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 916-2600
Hospital & facility affiliations
- Henry Ford Health Hospital
- Wyandotte Hospital and Medical Center
- Henry Ford Allegiance Health
- Henry Ford Health West Bloomfield Hospital
- Henry Ford Macomb Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 14 |
| Upper gastrointestinal (GI) endoscopy for acid reflux | 11 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301511164 | MI | MD | Gastroenterology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Henry Ford Health System | Current | Accepting new patients | |
| Henry Ford Health System | Current | Accepting new patients | |
| Henry Ford Health System | Gastroenterology | Current | Accepting new patients |
| W.a. Foote Memorial Hospital, Inc | Gastroenterology | Current | Accepting new patients |
| W. a. Foote Memorial Hospital, Inc | Internal Medicine | Current | Accepting new patients |
| W.a. Foote Memorial Hospital, Inc | Current | Accepting new patients | |
| Henry Ford Health System | Current | Accepting new patients |
Locations
2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062
1 Ford Pl
Ste 3A
Detroit, MI 48202
Phone (313) 874-2892
205 N East Ave
Jackson, MI 49201
Phone (517) 788-4730
813 W Michigan Ave
Jackson, MI 49202
Phone (517) 205-1000
205 N East Ave
Fl 5
Jackson, MI 49201
Phone (517) 205-3560
6777 W Maple Rd
West Bloomfield, MI 48322
Phone (248) 325-1000
Interoperability endpoints
- asu948411@direct.hfhs.org
Organizations & group practices 7
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.
-
- Internal Medicine Physician
- Jackson, MI
- NPI 1760437826
Internal Medicine, MI
-
- Physician Assistant
- Detroit, MI
- NPI 1811073901
-
- Community/Retail Pharmacy
- Plymouth, MI
- NPI 1942931720
-
- Gastroenterology Physician
- Jackson, MI
- NPI 1326585522
Gastroenterology
-
- Physician Assistant
- Jackson, MI
- NPI 1538606348
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Clinton TWP, MI
- NPI 1023114634
Hospital
-
- General Acute Care Hospital
- Warren, MI
- NPI 1902842735
Hospital
-
- Ambulatory Surgical Clinic/Center
- Wyandotte, MI
- NPI 1093901035
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736726400000",
"number": "1306334131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 FORD PL STE 3A",
"city": "DETROIT",
"state": "MI",
"postal_code": "482023450",
"telephone_number": "313-874-2892",
"fax_number": "313-876-1305"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2799 W GRAND BLVD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482022608",
"telephone_number": "313-916-8632"
}
],
"practiceLocations": [
{
"address_1": "1800 Orleans St",
"address_purpose": "LOCATION",
"city": "Baltimore",
"state": "MD",
"postal_code": "212870010",
"country_code": "US",
"telephone_number": "410-955-5000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "205 N East Ave Fl 5",
"address_purpose": "LOCATION",
"city": "Jackson",
"state": "MI",
"postal_code": "492011753",
"country_code": "US",
"telephone_number": "517-205-7618",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "6777 W Maple Rd",
"address_purpose": "LOCATION",
"city": "West Bloomfield",
"state": "MI",
"postal_code": "483223013",
"country_code": "US",
"telephone_number": "800-653-6568",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SU",
"first_name": "AMANDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-04-26",
"last_updated": "2025-01-13",
"certification_date": "2025-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "MI",
"license": "4301511164",
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "4301511164",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.