NPIMap

Individual provider Active NPI

Sujata Kambhatla, MD

  • Internal Medicine Physician
  • Garden City, MI
National Provider Identifier
1376679514
Registry record updated Nov 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
SK4301067805 Issued in MI
Practice address
5823 Middlebelt Rd
Garden City, MI 48135-2459
Phone
(734) 421-6333
NPI assigned
Feb 24, 2007
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
Internal Medicine Physician 207R00000X SK4301067805 MI Primary

Addresses

Primary practice location

5823 Middlebelt Rd
Garden City, MI 48135-2459

Mailing address

5823 Middlebelt Rd
Garden City, MI 48135-2459
Phone (734) 421-6333

Other identifiers 6

IdentifierTypeStateIssuer
104565305MedicaidMI
N20400001OtherMIMEDICARE RENDERRING ID
383564379OtherMITAX ID
SK067805OtherMILICENSE NUMBER
110827980OtherMIBCBS
1891767281OtherMIORGANIZATIONAL NPI

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
I20101118001000 MI Practitioner - Internal Medicine 2860688645 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Apollo Family Health Services PCGroup PAC ID 3173719952, 2 clinicians
Apollo Hospitalist GroupGroup PAC ID 5193194033, 15 clinicians

Practice addresses (Care Compare)

5823 Middlebelt Rd
Garden City, MI 48135-2459
Phone (734) 421-6333

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
SK4301067805MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Apollo Hospitalist Group CurrentSince Dec 1, 2022 Accepting new patients
Apollo Family Health Services PC Internal Medicine CurrentSince Aug 12, 2010 Accepting new patients
Prime Healthcare Services - Garden City LLC Past Accepting new patients

Locations

5823 Middlebelt Rd
Garden City, MI 48135
Phone (734) 421-6333

6245 Inkster Rd
Garden City, MI 48135
Phone (734) 421-3300

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CFHEBA
  • FHIR API: https://fhir4.healow.com/fhir/r4/CFHEBA/Endpoint/CFHEBA

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1172275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667779200000",
    "number": "1376679514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5823 MIDDLEBELT RD",
            "city": "GARDEN CITY",
            "state": "MI",
            "postal_code": "481352459",
            "telephone_number": "734-421-6333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5823 MIDDLEBELT RD",
            "city": "GARDEN CITY",
            "state": "MI",
            "postal_code": "481352459",
            "telephone_number": "734-421-6333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAMBHATLA",
        "first_name": "SUJATA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-24",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "SK4301067805",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104565305",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RENDERRING ID",
            "identifier": "N20400001",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "383564379",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "SK067805",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "110827980",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORGANIZATIONAL NPI",
            "identifier": "1891767281",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden City, MI

Sources for this page

Verify at the official NPI Registry.