Individual provider Active NPI

Sanjay Uppal, P.T, MHS

  • Physical Therapist
  • Southfield, MI
National Provider Identifier
1508827544
Registry record updated Oct 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501004980 Issued in MI
Practice address
26771 W 12 Mile Rd
Suite # 103
Southfield, MI 48034-1539
Phone
(248) 945-9905
Fax
(248) 945-9906
NPI assigned
Mar 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501004980 MI Primary

Addresses

Primary practice location

26771 W 12 Mile Rd
Suite # 103
Southfield, MI 48034-1539

Mailing address

6571 Shadowood Dr
West Bloomfield, MI 48322-3295
Phone (248) 895-1320

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120117000859 MI Practitioner - Physical Therapist in Private Practice 0941262174 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

26771 W 12 Mile Rd
Southfield, MI 48034-1539
Phone (248) 945-9905

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5501004980MIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Rehabilitation and Physical Therapy Inc. Physical Therapist CurrentSince Sep 1, 2001 Accepting new patients

Locations

26771 W 12 Mile Rd
Ste 103
Southfield, MI 48034
Phone (248) 945-9905

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Southeast Home Health Care, L.L.CSouthfield, MI, CCN 239064 Home health agency 5% Or Greater Direct Ownership Interest (50%)
Corporate Officer (50%)
Corporate Director (50%)
W-2 Managing Employee
Sep 18, 2007
Sep 18, 2007
Sep 18, 2007
Sep 18, 2007

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286928000000",
    "number": "1508827544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6571 SHADOWOOD DR",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483223295",
            "telephone_number": "248-895-1320",
            "fax_number": "248-945-9906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26771 W 12 MILE RD",
            "address_2": "SUITE # 103",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341539",
            "telephone_number": "248-945-9905",
            "fax_number": "248-945-9906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UPPAL",
        "first_name": "SANJAY",
        "name_prefix": "Mr.",
        "credential": "P.T, MHS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2010-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501004980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.