Vijaya Gopal Kotha, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

4301058577 Issued in MI

Practice address

215 North Ave
Mount Clemens, MI 48043-1716

Phone

(313) 580-6760

NPI assigned

Aug 13, 2006

Last updated

Mar 31, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

PsychiatryAlso: Neurology

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Bal K Gupta MD PCGroup PAC ID 5193779189, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Henry Ford Health Warren Hospital Hospital, Warren, MI, CCN 230195

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/macombfamily/r4/
• Direct secure messaging: vijayakothamd@bkguptamd.cernerdirect.com
• Direct secure messaging: vkotha9251@direct.hfhs.org

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.

• Bal K Gupta MD PC

  • Psychiatry Physician
  • Warren, MI
  • NPI 1306937339
  Medicare reassignment Care Compare group NPD
• Henry Ford Health System

  • General Acute Care Hospital
  • Detroit, MI
  • NPI 1134144801
  Medicare reassignment Care Compare group NPD
• Henry Ford Macomb Hospital Corporation

  dba Henry Ford Macomb Family Medicine

  • Family Medicine Physician
  • Clinton TWP, MI
  • NPI 1134265986
  Medicare reassignment NPD
• Henry Ford Health System

  • Psychiatry Physician
  • Detroit, MI
  • NPI 1447334750
  NPD
• Henry Ford Health System

  • Community/Retail Pharmacy
  • Plymouth, MI
  • NPI 1942931720
  NPD
• Henry Ford Macomb Hospital Corporation

  • Psychiatry Physician
  • Clinton Township, MI
  • NPI 1003950015
  NPD
• Henry Ford Macomb Hospital Corporation

  dba Henry Ford Health Macomb Hospital

  • General Acute Care Hospital
  • Clinton TWP, MI
  • NPI 1023114634
  NPD
• Henry Ford Pathology

  • Anatomic Pathology & Clinical Pathology Physician
  • Detroit, MI
  • NPI 1851410005
  NPD
• Henry Ford Health Macomb Oakland Hospital

  dba St. John Macomb Oakland Hospital-Warren Campus

  • General Acute Care Hospital
  • Warren, MI
  • NPI 1124099858
  NPD (past)
• Henry Ford Health Macomb Oakland Hospital

  dba St. John Macomb Oakland Hospital-Warren Campus

  • Psychiatric Hospital Unit
  • Warren, MI
  • NPI 1306816426
  NPD (past)
• Henry Ford Health System

  • Psychiatric Hospital
  • West Bloomfield, MI
  • NPI 1710918362
  NPD (past)
• HFHS-Acadia Joint Venture, LLC

  dba Henry Ford Health Behavioral Health Hospital

  • Psychiatric Hospital
  • West Bloomfield, MI
  • NPI 1073359717
  NPD (past)

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

• Henry Ford Health Macomb Oakland Hospital

  dba St. John Macomb Oakland Hospital-Warren Campus

  • General Acute Care Hospital
  • Warren, MI
  • NPI 1124099858
  Care Compare affiliation
• Henry Ford Health Macomb Oakland Hospital

  dba St John Macomb Oakland - Oakland Center

  • General Acute Care Hospital
  • Madison Heights, MI
  • NPI 1215139233
  Care Compare affiliation

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617148800000",
    "number": "1386657427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11900 E TWELVE MILE RD",
            "address_2": "SUITE 111",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933472",
            "telephone_number": "586-573-5300",
            "fax_number": "586-573-5304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 NORTH AVE",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480431716",
            "telephone_number": "313-580-6760"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11900 E Twelve Mile Rd",
            "address_2": "Suite 111",
            "address_purpose": "LOCATION",
            "city": "Warren",
            "state": "MI",
            "postal_code": "480933472",
            "country_code": "US",
            "telephone_number": "586-573-5300",
            "fax_number": "586-573-5304",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOTHA",
        "first_name": "VIJAYA",
        "middle_name": "GOPAL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301058577",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4224674",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "26OE011140",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vkotha9251@direct.hfhs.org",
            "affiliation": "Y",
            "affiliationName": "Henry Ford Macomb Hospital Corporation",
            "address_1": "215 North Ave",
            "city": "Mount Clemens",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480431716",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Evan Knill, LLPC
• Zachary Koch, DO
• Patricia Anna Kogut, DPM
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• Sonali Soral Kopke, D.O.
• Jaclyn Suzette Kournoian, NP-C
• Peter A Kovalszki, MD
• Benjamin Krater, D.O.
• Krauseneck Chiropractic, PLC
• Barbara Jean Krauseneck, CPNP

• Psychiatry Physician in Mount Clemens, MI
• Providers in Mount Clemens, MI by specialty
• Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.