Individual provider Active NPI

Prakash Chinnaiyan, M.D.

  • Radiation Oncology Physician
  • Royal Oak, MI
National Provider Identifier
1467402172
Registry record updated Oct 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
4301106591 Issued in MI
Practice address
3577 W 13 Mile Rd
Royal Oak, MI 48073-6710
Phone
(248) 551-7020
NPI assigned
May 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Therapeutic Radiology Physician 2085R0203X 47459 WI
Radiation Oncology Physician 2085R0001X 4301106591 MI Primary

Addresses

Primary practice location

3577 W 13 Mile Rd
Royal Oak, MI 48073-6710

Mailing address

26901 Beaumont Blvd Ste 3D
Southfield, MI 48033-3849

Other identifiers 2

IdentifierTypeStateIssuer
91404OtherFLBLUE CROSS BLUE SHIELD
277447000MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pchinnaiyan82973@direct.beaumont.edu

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20150210001824 MI Practitioner - Radiation Oncology 6406950823 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Wayne State University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beaumont Medical Group- Specialty ServicesGroup PAC ID 7214299866, 868 clinicians

Practice addresses (Care Compare)

18101 Oakwood Blvd
Dearborn, MI 48124-4089

28100 Grand River Ave
Farmington Hills, MI 48336-5970

3555 W 13 Mile Rd
Royal Oak, MI 48073-6710

3577 W 13 Mile Rd
Royal Oak, MI 48073-6710

3581 W 13 Mile Rd BCC
Beaumont Breast Care Center
Royal Oak, MI 48073-6710
Phone (248) 551-3300

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712

3601 W 13 Mile Rd Ec
Beaumont Emergency Services Ro
Royal Oak, MI 48073-6712
Phone (248) 898-5058

Hospital & facility affiliations

  • Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130
  • Beaumont Hospital, Troy Hospital, Troy, MI, CCN 230269

Merit-based Incentive Payment System (MIPS)

Final score
84.37 of 100Reported as group
Quality
66.73
Promoting interoperability
100
Improvement activities
40
Cost
70.98

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301106591MIMDRadiation Oncology Physician
47459WIMDTherapeutic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beaumont Medical Group- Specialty Services CurrentSince Mar 14, 2018 Accepting new patients
William Beaumont Hospital Past Accepting new patients

Locations

18101 Oakwood Blvd
Dearborn, MI 48124
Phone (313) 593-8780

28100 Grand River Ave
Ste 301
Farmington Hills, MI 48336
Phone (947) 521-1320

36555 26 Mile Rd
Ste 1500
Lenox, MI 48048
Phone (947) 523-4030

3577 W 13 Mile Rd
Royal Oak, MI 48073
Phone (248) 551-5490

3535 W 13 Mile Rd
Royal Oak, MI 48073
Phone (248) 551-1010

3601 W 13 Mile Rd
Royal Oak, MI 48073

3581 W 13 Mile Rd
Ste Ll
Royal Oak, MI 48073
Phone (248) 551-6689

26901 Beaumont Blvd
Ste 3D
Southfield, MI 48033
Phone (947) 522-1860

44201 Dequindre Rd
Ste 615
Troy, MI 48085

5450 Fort St
Woodhaven, MI 48183
Phone (734) 671-3297

Interoperability endpoints

  • Direct secure messaging: pchinnaiyan1228743@epic00.shdirect.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1467402172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3577 W 13 MILE RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736710",
            "telephone_number": "248-551-7020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHINNAIYAN",
        "first_name": "PRAKASH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0203X",
            "taxonomy_group": "",
            "desc": "Radiology, Therapeutic Radiology",
            "state": "WI",
            "license": "47459",
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "MI",
            "license": "4301106591",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "91404",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "277447000",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pchinnaiyan82973@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "3577 W 13 Mile Rd",
            "city": "Royal Oak",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480736710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Royal Oak, MI

Sources for this page

Verify at the official NPI Registry.