NPIMap

Individual provider Active NPI

Kishan Kumar Jasti, M.D.

  • Cardiovascular Disease Physician
  • Roseville, MI
National Provider Identifier
1346248135
Registry record updated Oct 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
4301088186 Issued in MI
Practice address
25195 Kelly Road
Suite a
Roseville, MI 48066-4909
Phone
(586) 775-4594
Fax
(586) 775-4506
NPI assigned
Jul 14, 2005
Last updated
Oct 16, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD424918 PA
Cardiovascular Disease Physician 207RC0000X 4301088186 MI Primary
Nuclear Cardiology Physician 207UN0901X 4301088186 MI

Addresses

Primary practice location

25195 Kelly Road
Suite a
Roseville, MI 48066-4909

Mailing address

25195 Kelly Road
Suite a
Roseville, MI 48066-4909
Phone (586) 775-4594

Other identifiers 4

IdentifierTypeStateIssuer
060502617OtherMIBCBS
1346248135MedicaidMI
3810011127MedicaidWV
1013818260002MedicaidPA

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
I20110801000842 MI Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal MedicinePractitioner - Other (Physician) 2769412998 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

25195 Kelly Rd
Suite a
Roseville, MI 48066-5084
Phone (586) 775-4594

27351 Dequindre Rd
Madison Heights, MI 48071-3487
Phone (248) 967-7000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as apm

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301088186MIMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health St. John Hospital CurrentSince Oct 1, 2018 Accepting new patients
Henry Ford Health St. John Hospital Current Accepting new patients
Henry Ford Semi Medical Group CurrentSince Jun 6, 2017 Accepting new patients
Henry Ford Semi Medical Group Internal Medicine CurrentSince Jun 6, 2017 Accepting new patients
Henry Ford Health Providence Hospital Cardiovascular Disease CurrentSince Jan 4, 2026 Accepting new patients
Henry Ford Health Providence Hospital CurrentSince Jan 4, 2026 Accepting new patients
Henry Ford Health St. John Hospital Internal Medicine CurrentSince Oct 1, 2018 Accepting new patients
Henry Ford Health St. John Hospital Internal Medicine Current Accepting new patients
Henry Ford Semi Medical Group Internal Medicine Current Accepting new patients
Mercy Management of Southeastern Pennsylvania Past Accepting new patients
Henry Ford Health Providence Hospital Past Accepting new patients

Locations

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

22201 Moross Rd
Grosse Pointe Woods, MI 48236
Phone (313) 343-6530

17900 23 Mile Rd
Ste 404
Macomb, MI 48044
Phone (586) 286-7800

27351 Dequindre Rd
Madison Hts, MI 48071
Phone (248) 967-7000

26850 Providence Pkwy
Ste 205
Novi, MI 48374
Phone (248) 465-3144

1101 W University Dr
Rochester Hls, MI 48307
Phone (248) 601-4805

1135 W University Dr
Ste 210
Rochester Hls, MI 48307
Phone (248) 650-4660

25195 Kelly Rd
Ste A
Roseville, MI 48066
Phone (586) 775-4594

16001 W 9 Mile Rd
Fl 5
Southfield, MI 48075
Phone (248) 380-4335

37771 Schoenherr Rd
Ste 104
Sterling Hts, MI 48312
Phone (810) 286-0050

11800 E 12 Mile Rd
Warren, MI 48093
Phone (586) 573-5000

28000 Dequindre Rd
Warren, MI 48092
Phone (586) 743-0944

30117 Schoenherr Rd
Ste 400
Warren, MI 48088
Phone (586) 552-4848

Interoperability endpoints

  • Direct secure messaging: kishan.jasti.2@8209.direct.athenahealth.com
  • Direct secure messaging: kjasti248913@direct.hfhs.org

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 7

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": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444953600000",
    "number": "1346248135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25195 KELLY ROAD",
            "address_2": "SUITE A",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664909",
            "telephone_number": "586-775-4594",
            "fax_number": "586-775-4506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25195 KELLY ROAD",
            "address_2": "SUITE A",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664909",
            "telephone_number": "586-775-4594",
            "fax_number": "586-775-4506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JASTI",
        "first_name": "KISHAN",
        "middle_name": "KUMAR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-14",
        "last_updated": "2015-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD424918",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": "4301088186",
            "primary": true
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "MI",
            "license": "4301088186",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "060502617",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346248135",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810011127",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013818260002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MI

Sources for this page

Verify at the official NPI Registry.