NPIMap

Individual provider Active NPI

Amitha Parvataneni, MD

  • Family Medicine Physician
  • Saint Clair Shores, MI
National Provider Identifier
1336326362
Registry record updated Nov 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301089533 Issued in MI
Practice address
28001 Harper Ave
Saint Clair Shores, MI 48081-1561
Phone
(586) 772-7180
Fax
(586) 279-0033
NPI assigned
Jan 22, 2008
Last updated
Nov 7, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301089533 MI Primary

Addresses

Primary practice location

28001 Harper Ave
Saint Clair Shores, MI 48081-1561

Mailing address

28001 Harper Ave
Saint Clair Shores, MI 48081-1561
Phone (586) 772-7180

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200206000914 MI Practitioner - Family PracticePractitioner - Internal Medicine 8628219441 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Geriatric Associates of Michigan, PLLCGroup PAC ID 9436400447, 7 clinicians
Lifesmart Medical Center PLLCGroup PAC ID 5193263143, 3 clinicians

Practice addresses (Care Compare)

137 Keveling Dr
Saline, MI 48176-1197
Phone (586) 393-1330

2176 Fort St
Lincoln Park, MI 48146-2405
Phone (313) 499-8556

33300 Utica Rd
Fraser, MI 48026-2017
Phone (586) 293-3300

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Lifesmart Medical Center PLLC Family Medicine CurrentSince Jul 13, 2024 Accepting new patients
Primary Healthcare Doctors PLLC CurrentSince Oct 1, 2022 Accepting new patients
Community Home Physicians, LLC Family Medicine CurrentSince Feb 15, 2025 Accepting new patients
Geriatric Associates of Michigan, PLLC CurrentSince Feb 15, 2025 Accepting new patients
JS Dudovitz, Inc Past Accepting new patients

Locations

1S450 Summit Ave
Ste 165
Oakbrook Terrace, IL 60181
Phone (630) 320-6871

3160 Lewis Ave
Ida, MI 48140
Phone (630) 320-6871

2176 Fort St
Lincoln Park, MI 48146
Phone (248) 948-7985

16800 24 Mile Rd
Ste 4
Macomb, MI 48042
Phone (586) 786-1800

137 Keveling Dr
Saline, MI 48176
Phone (586) 393-1330

28001 Harper Ave
St Clr Shores, MI 48081
Phone (586) 772-7180

3281 Rochester Rd
Troy, MI 48083
Phone (313) 768-5096

14030 E 14 Mile Rd
Warren, MI 48088
Phone (586) 286-3260

28655 Hoover Rd
Warren, MI 48093
Phone (586) 393-1330

6400 Industrial Loop
Greendale, WI 53129
Phone (414) 423-4100

Interoperability endpoints

  • Direct secure messaging: aparvataneni1143932@direct.hfhs.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1200960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667779200000",
    "number": "1336326362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28001 HARPER AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811561",
            "telephone_number": "586-772-7180",
            "fax_number": "586-279-0033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28001 HARPER AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811561",
            "telephone_number": "586-772-7180",
            "fax_number": "586-279-0033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARVATANENI",
        "first_name": "AMITHA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-22",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301089533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

Verify at the official NPI Registry.