Sasi B Boppana, M.D.
Individual provider Active NPI Internal Medicine Physician · Wayne, MI
NPI 1528053196 · NPPES record last updated Dec 25, 2017
Key facts
- NPI
- 1528053196
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 4301073741 (MI)
- Practice address
- 34659 W Michigan Ave
Wayne, MI 48184-1730 - Phone
- (734) 722-2400
- Fax
- (734) 722-1709
- NPI assigned
- Sep 20, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 12
Medicare Care Compare profile
- 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 PC
Practice addresses (Care Compare)
34659 W Michigan Ave
Wayne, MI 48184-1730
Phone (734) 722-2400
Hospital & facility affiliations
- Beacon Hospice of Michigan LP
- Corewell Health Wayne Hospital
- Beaumont Hospital - Dearborn
- Beaumont Hospital - Farmington Hills
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070710000535 | MI | Practitioner - Internal Medicine | 6901906759 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kavitha Ponduri MD PC | Internal Medicine | Current |
Accepting new patients |
| Oakwood Healthcare, Inc. | Past | Accepting new patients |
Locations
34659 W Michigan Ave
Wayne, MI 48184
Phone (734) 722-2400
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/ADECCA/Endpoint/ADECCA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 4301073741 | MI | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4580740 | Medicaid | MI |
Other providers in Wayne, MI
- Madelyn Board
- Elisha Boeskool
- Eddie Boles III
- Emma Bond
- Anna Bondy
- Finnegan Jae Born
- Franklin Carl Bosworth III
- Daniel Bota
- Alec Justin Botros
- Ashley Bouchard
All providers in Wayne, MI · Internal Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 25, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.