Active NPI
Pooja Kodali, MD
- Family Medicine Physician
- Detroit, MI
National Provider Identifier
1477040608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4301511158
- Practice address
- 16226 Grand River Ave
Detroit, MI 48227-1824 - Phone
- (313) 836-5491
- Fax
- (313) 836-5224
- NPI assigned
- Apr 13, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301511158 | MI | Primary |
Addresses
Primary practice location
16226 Grand River Ave
Detroit, MI 48227-1824
Mailing address
16828 Horseshoe Dr
Northville, MI 48168-8586
Phone (248) 277-8703
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
16226 Grand River Ave
Detroit, MI 48227-1824
Phone (313) 960-6605
Hospital & facility affiliations
- Beaumont Hospital - Farmington Hills
- Beaumont Hospital Royal Oak
- Beaumont Hospital - Dearborn
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301511158 | MI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Metrohealth System | Current | Accepting new patients | |
| Advanced MD Specialty Care PLLC | Current | Accepting new patients |
Locations
15400 N Commerce Dr
Dearborn, MI 48120
Phone (313) 960-6605
16226 Grand River Ave
Detroit, MI 48227
Phone (313) 836-5490
Interoperability endpoints
- pkodali143084@direct.metrohealth.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.
-
- Internal Medicine Physician
- Detroit, MI
- NPI 1225719693
-
- General Acute Care Hospital
- Cleveland, OH
- NPI 1700828852
Hospital & facility affiliations 13
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Farmington Hills, MI
- NPI 1336183367
-
- General Acute Care Hospital
- Dearborn, MI
- NPI 1740230119
-
- General Acute Care Hospital
- Troy, MI
- NPI 1306825997
-
- General Acute Care Hospital
- Royal Oak, MI
- NPI 1689653305
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1523577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713484800000",
"number": "1477040608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16828 HORSESHOE DR",
"city": "NORTHVILLE",
"state": "MI",
"postal_code": "481688586",
"telephone_number": "248-277-8703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16226 GRAND RIVER AVE",
"city": "DETROIT",
"state": "MI",
"postal_code": "482271824",
"telephone_number": "313-836-5491",
"fax_number": "313-836-5224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KODALI",
"first_name": "POOJA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-04-13",
"last_updated": "2024-04-19",
"certification_date": "2024-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4301511158",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2024; 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.