NPIMap

Individual provider Active NPI

Sasi B Boppana, M.D.

  • Internal Medicine Physician
  • Wayne, MI
National Provider Identifier
1528053196
Registry record updated Dec 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301073741 Issued in MI
Practice address
34659 W Michigan Ave
Wayne, MI 48184-1730
Phone
(734) 722-2400
Fax
(734) 722-1709
NPI assigned
Sep 20, 2005
Last updated
Dec 25, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 25, 2017

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 4301073741 MI Primary

Addresses

Primary practice location

34659 W Michigan Ave
Wayne, MI 48184-1730

Mailing address

34659 W Michigan Ave
Wayne, MI 48184-1730
Phone (734) 722-2400

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
I20070710000535 MI Practitioner - Internal Medicine 6901906759 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kavitha Ponduri MD PCGroup PAC ID 5395845143, 2 clinicians

Practice addresses (Care Compare)

34659 W Michigan Ave
Wayne, MI 48184-1730
Phone (734) 722-2400

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Kavitha Ponduri MD PC Internal Medicine CurrentSince Jul 1, 2007 Accepting new patients
Oakwood Healthcare, Inc. Past Accepting new patients

Locations

34659 W Michigan Ave
Wayne, MI 48184
Phone (734) 722-2400

Interoperability endpoints

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

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": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514160000000",
    "number": "1528053196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34659 W MICHIGAN AVE",
            "city": "WAYNE",
            "state": "MI",
            "postal_code": "481841730",
            "telephone_number": "734-722-2400",
            "fax_number": "734-722-1709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34659 W MICHIGAN AVE",
            "city": "WAYNE",
            "state": "MI",
            "postal_code": "481841730",
            "telephone_number": "734-722-2400",
            "fax_number": "734-722-1709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOPPANA",
        "first_name": "SASI",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2017-12-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301073741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayne, MI

Sources for this page

Verify at the official NPI Registry.