Shivashankar Damodaran, MD

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

4301508337 Issued in MI

Practice address

2611 Electric Ave Ste E
Port Huron, MI 48060-6587

Phone

(810) 216-3599

NPI assigned

May 17, 2018

Last updated

May 25, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Urology

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Port Huron Physicians Medical Group PCGroup PAC ID 0840507802, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lake Huron Medical Center Hospital, Port Huron, MI, CCN 230031

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Port Huron Physicians Medical Group PC

  dba Lake Huron Medical Group

  • Family Medicine Physician
  • Fort Gratiot, MI
  • NPI 1598141640
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Prime Healthcare Services-Port Huron LLC

  • General Acute Care Hospital
  • Port Huron, MI
  • NPI 1306227764
  Care Compare affiliation

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

{
    "created_epoch": "1526515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748131200000",
    "number": "1528558277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2611 ELECTRIC AVE STE E",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480606587",
            "telephone_number": "810-216-3599",
            "fax_number": "833-329-4076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2611 ELECTRIC AVE STE E",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480606587",
            "telephone_number": "810-216-3599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAMODARAN",
        "first_name": "SHIVASHANKAR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-17",
        "last_updated": "2025-05-25",
        "certification_date": "2025-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MI",
            "license": "4301508337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emad Daher, MD
• Laura Dahnke, RDN, CDE
• Geeta Dalal, PT
• Kanu B Dalal, MD
• Heather Dalessio
• Melissa Damon
• Daniel J Wilhelm MD PLLC
• Julia Ashley Daniel, LMSW
• Mary Catherine Daniel, LMSW
• Ann-Marie Daniels-Hillman, LMSW, CAADC

• Urology Physician in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Urology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2025; 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.

Verify at the official NPI Registry.