Kourosh Baghelai, M.D.
Individual provider Active NPI Vascular Surgery Physician · Saint Joseph, MI
NPI 1366434987 · NPPES record last updated Oct 15, 2012
Key facts
- NPI
- 1366434987
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Vascular Surgery Physician 2086S0129X
- License
- 4301084433 (MI)
- Practice address
- 2500 Niles Rd Ste 6
Saint Joseph, MI 49085-3268 - Phone
- (269) 408-1660
- Fax
- (269) 408-1665
- NPI assigned
- Aug 19, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Cardiac Surgery
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lakeland Hospitals at Niles and St Joseph Inc
Practice addresses (Care Compare)
1234 Napier Ave
Corewell Health Lakeland Hospitals
Saint Joseph, MI 49085-2112
Phone (269) 983-8300
Hospital & facility affiliations
- Corewell Health Lakeland Hospitals St Joseph Hospital
- Lakeland Hospital, St Joseph
- Corewell Health Watervliet Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Coronary artery bypass graft (CABG) | 12 |
| Pacemaker insertion or repair | 1-10 |
| Leg revascularization (restoring blood flow) | 25 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041001000421 | MI | Practitioner - Cardiac Surgery |
3779552146 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakeland Hospitals at Niles and St Joseph, Inc | Current |
Accepting new patients | |
| Lakeland Hospitals at Niles and St Joseph, Inc | Current |
Accepting new patients |
Locations
6559 Paw Paw Ave
Coloma, MI 49038
Phone (269) 408-1660
61 N Saint Joseph Ave
Niles, MI 49120
Phone (269) 684-6777
1234 Napier Ave
Saint Joseph, MI 49085
Phone (269) 982-4941
2500 Niles Rd
Ste 1
Saint Joseph, MI 49085
Phone (269) 429-5000
2500 Niles Rd
Ste 6
Saint Joseph, MI 49085
Phone (269) 408-1660
Interoperability endpoints
- kbaghelai7628@lakeland.midirect.net
- kbaghelai1224137@epic00.corewelldirect.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician | 2086S0129X | 4301084433 | MI | Yes |
Addresses
Primary practice location
2500 Niles Rd Ste 6
Saint Joseph, MI 49085-3268
Mailing address
2500 Niles Rd Ste 6
Saint Joseph, MI 49085-3268
Phone (269) 408-1660
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 104638715 | Medicaid | MI |
Other providers in Saint Joseph, MI
- Julia E Austen
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- Margaretha Baestaens
- Bidisha Bagchi
- Abigail Jane Baker
- Alina McBride Baltazar
- John L Bard
- Savannah Rose Bares
- Thomas Christopher Barker
All providers in Saint Joseph, MI · Vascular Surgery Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.