Shivani V Kondagunta, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601013554 Issued in MI

Practice address

259 Mack Ave
Detroit, MI 48201-2427

Phone

(313) 577-1716

NPI assigned

Jul 2, 2025

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

Electronic endpoints 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Wayne State University School of Medicine, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Huron Gastroenterology Associates PCGroup PAC ID 0840288221, 95 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Trinity Health Ann Arbor Hospital Hospital, Ann Arbor, MI, CCN 230156

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: hurongastro@directaddress.net
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Huron Gastroenterology Associates PC

  • Gastroenterology Physician
  • Ypsilanti, MI
  • NPI 1144335639
  Medicare reassignment Care Compare group NPD
• Huron Gastroenterology Associates PC

  • Gastroenterology Physician
  • Howell, MI
  • NPI 1265635593
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Joseph Mercy Hospital

  • General Acute Care Hospital
  • Ypsilanti, MI
  • NPI 1780658443
  Care Compare affiliation

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

{
    "created_epoch": "1751414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772150400000",
    "number": "1306735311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 ELLIOTT DR",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481978632",
            "telephone_number": "734-434-6262",
            "fax_number": "734-712-2820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "259 MACK AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012427",
            "telephone_number": "313-577-1716"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5300 Elliott Dr",
            "address_purpose": "LOCATION",
            "city": "Ypsilanti",
            "state": "MI",
            "postal_code": "481978632",
            "country_code": "US",
            "telephone_number": "734-434-6262",
            "fax_number": "734-712-2820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KONDAGUNTA",
        "first_name": "SHIVANI",
        "middle_name": "V",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-02",
        "last_updated": "2026-02-27",
        "certification_date": "2026-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601013554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hurongastro@directaddress.net",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "XML,PDF",
            "address_1": "5300 Elliott Dr",
            "city": "Ypsilanti",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481978632",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Komfort Kare Solutions LLC
• Rachel Lorraine Konchal, MD
• Koncorda Inc
• Sasank Konda, M.D.
• Srinivas Konda
• Efstathios Kondylis, M.D.
• Sirisha Koneru, M.D.
• Wan Yee Kong, M.D
• Wing Tai Kong, MD
• Betsey Amber Hope Konieczki, BSW

• Physician Assistant in Detroit, MI
• Providers in Detroit, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2026; 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.

Verify at the official NPI Registry.