Professional Primary Care Services PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301068131 Issued in MI

Legal business name

PROFESSIONAL PRIMARY CARE SERVICES PC

Practice address

43996 Woodward Ave Ste 104
Bloomfield Hills, MI 48302-5028

Phone

(248) 977-4138

NPI assigned

Oct 11, 2007

Organization subpart

No

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

Authorized official

Name

Jayakar Reddy Kanmantha Reddy, M.D.NPI 1629086244

Title

President

Phone

(248) 396-6667

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jayakar Reddy Kanmantha Reddy, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Waterford Township, MI
  • NPI 1629086244
  Medicare reassignment NPD Authorized official
• Yash P Lakra, MD

  • Surgery Physician
  • Bloomfield Hills, MI
  • NPI 1689694929
  NPD (past)

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

{
    "created_epoch": "1192060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310342400000",
    "number": "1588852933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7752",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483027752",
            "telephone_number": "248-396-6667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43996 WOODWARD AVE STE 104",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483025028",
            "telephone_number": "248-977-4138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL PRIMARY CARE SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-11",
        "last_updated": "2011-07-11",
        "status": "A",
        "authorized_official_last_name": "KANMANTHA REDDY",
        "authorized_official_first_name": "JAYAKAR REDDY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-396-6667",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301068131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Dawn Price, FNP-BC
• Primary Medicine PC
• Professional Assisted Living Inc
• Professional Consultants Inc
• Professional Diagnostic Imagiging PLLC
• Progressive Residential Services, Inc.
• Project Home Health
• Prompt Care Home Health Services, Inc.
• Prosperity Health PC
• Lisa Provenzano, N.P.

• Internal Medicine Physician in Bloomfield Hills, MI
• Providers in Bloomfield Hills, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.