NPIMap

Individual provider Active NPI

Shathabish Kariyanna, MD

  • Family Medicine Physician
  • Ann Arbor, MI
National Provider Identifier
1346683869
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301113435 Issued in MI
Practice address
3120 Professional Dr
Ann Arbor, MI 48104-5131
Phone
(734) 677-6000
NPI assigned
Apr 15, 2013
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 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 4301113435 MI Primary

Addresses

Primary practice location

3120 Professional Dr
Ann Arbor, MI 48104-5131

Mailing address

3120 Professional Dr
Ann Arbor, MI 48104-5131
Phone (734) 677-6000

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
I20170919002391 MI Practitioner - Family PracticePractitioner - Internal MedicinePractitioner - Pain Management 8921394768 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Internal Medicine, Pain Management
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3120 Professional Dr
Ann Arbor, MI 48104-5131
Phone (734) 677-6000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301113435MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Organizations & group practices 3

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 6

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": "1365984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1346683869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 PROFESSIONAL DR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481045131",
            "telephone_number": "734-677-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3120 PROFESSIONAL DR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481045131",
            "telephone_number": "734-677-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KARIYANNA",
        "first_name": "SHATHABISH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-15",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301113435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.