Gurkanwal Sidhu, M.D.

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

2006 Hogback Rd Ste 1
(St. Mary Mercy Outpatient Psychiatric Services)
Ann Arbor, MI 48105-9750

Phone

(734) 786-3000

NPI assigned

Apr 15, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

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

Psychiatry

Education

Wayne State University School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Copper Country Community Mental Health ServicesGroup PAC ID 8426119256, 9 clinicians

West Michigan Community Mental Health SystemGroup PAC ID 8426046855, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Copper Country Community Mental Health Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Houghton, MI
  • NPI 1881607497
  Medicare reassignment Care Compare group NPD
• West Michigan Community Mental Health System

  • Mental Health Counselor
  • Ludington, MI
  • NPI 1275646309
  Medicare reassignment Care Compare group NPD
• Victor M. Cruz MD, P.C.

  • Psychiatry Physician
  • Livonia, MI
  • NPI 1023036514
  Medicare reassignment NPD
• Copper Country Community Mental Health Services

  • Community/Behavioral Health Agency
  • Ontonagon, MI
  • NPI 1780871137
  NPD
• West Michigan Community Mental Health System

  • Primary Care Nurse Practitioner
  • Ludington, MI
  • NPI 1376017889
  NPD
• Boysville of Michigan, Inc.

  • Addiction (Substance Use Disorder) Counselor
  • Pontiac, MI
  • NPI 1184061426
  NPD (past)

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

{
    "created_epoch": "1397520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593475200000",
    "number": "1598184665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 4TH ST",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118015407",
            "telephone_number": "516-395-8867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2006 HOGBACK RD STE 1",
            "address_2": "(ST. MARY MERCY OUTPATIENT PSYCHIATRIC SERVICES)",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481059750",
            "telephone_number": "734-786-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3400 S Washington Rd",
            "address_purpose": "LOCATION",
            "city": "Saginaw",
            "state": "MI",
            "postal_code": "486014958",
            "country_code": "US",
            "telephone_number": "989-755-1072",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIDHU",
        "first_name": "GURKANWAL",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-15",
        "last_updated": "2020-06-30",
        "certification_date": "2020-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301105629",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.holycrossservices.org",
            "affiliation": "N",
            "address_1": "3400 S Washington Rd",
            "city": "Saginaw",
            "state": "MI",
            "country_code": "US",
            "postal_code": "486014958",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Adam Ali Siddiqui, PA-C
• Asma W Siddiqui, MD
• Madiha Naqsh Siddiqui, MD
• Mariam Tahir Siddiqui, BDS, MS
• Razia R Siddiqui, PH.D
• Vickie Lynn Sidon, RN
• Christopher Sidwell, MD
• Lauren Marie Siebenaler
• Ronald Siebenaler, MD, PHD
• Daniel Siebenaller, PA-C

• Student in an Organized Health Care Education/Training Program in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Student in an Organized Health Care Education/Training Program in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2020; 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.