Individual provider Active NPI

Jeanne Therese Gugudis, NP

  • Nurse Practitioner
  • Detroit, MI
National Provider Identifier
1316425424
Registry record updated Feb 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704176174 Issued in MI
Practice address
2800 W Grand Blvd
Detroit, MI 48202-2610
Phone
(313) 799-6619
NPI assigned
Jul 31, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704176174 MI Primary

Addresses

Primary practice location

2800 W Grand Blvd
Detroit, MI 48202-2610

Mailing address

16705 Walter St
Southgate, MI 48195-2984
Phone (734) 281-1543

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jgugudi1@direct.hfhs.org

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181022000223 MI Practitioner - Nurse Practitioner 2961755962 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 916-2600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Parvez Khan MD PC, CurrentSince Oct 1, 2018 Accepting new patients
Henry Ford Health System Nurse Practitioner CurrentSince Jan 1, 2019 Accepting new patients
Henry Ford Health System CurrentSince Jan 1, 2019 Accepting new patients
Henry Ford Maplegrove Center Past Accepting new patients

Locations

861 Monroe St
Dearborn, MI 48124
Phone (313) 274-1800

831 Monroe St
Ste B
Dearborn, MI 48124
Phone (313) 274-1800

2800 W Grand Blvd
Detroit, MI 48202
Phone (313) 230-1078

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

39450 W Twelve Mile Rd
Novi, MI 48377
Phone (248) 344-0710

Interoperability endpoints

  • Direct secure messaging: jgugudis561546@direct.hfhs.org

Organizations & group practices 4

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1532995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613347200000",
    "number": "1316425424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16705 WALTER ST",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952984",
            "telephone_number": "734-281-1543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022610",
            "telephone_number": "313-799-6619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUGUDIS",
        "first_name": "JEANNE",
        "middle_name": "THERESE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-31",
        "last_updated": "2021-02-15",
        "certification_date": "2021-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704176174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jgugudi1@direct.hfhs.org",
            "affiliation": "N",
            "address_1": "2799 W Grand Blvd",
            "city": "Detroit",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482022608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.