Pensri P Geletka

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704299683NSA2403O Issued in MI

Practice address

15150 Fort St
Southgate, MI 48195-1302

Phone

(734) 282-4800

Fax

(734) 282-9302

NPI assigned

Feb 22, 2024

Last updated

Nov 24, 2024By the provider in NPPES

Sex

Female

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pgeletka1021441@direct.hfhs.org

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.

• Downriver Heart and Vascular Specialists PC

  • Interventional Cardiology Physician
  • Southgate, MI
  • NPI 1194838383
  NPD

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

{
    "created_epoch": "1708560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732406400000",
    "number": "1609632256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15150 FORT ST",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481951302",
            "telephone_number": "734-282-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15150 FORT ST",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481951302",
            "telephone_number": "734-282-4800",
            "fax_number": "734-282-9302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GELETKA",
        "first_name": "PENSRI",
        "middle_name": "P",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-22",
        "last_updated": "2024-11-24",
        "certification_date": "2024-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704299683NSA2403O",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judith M Garf, OTR
• Garfield Road Dental- 2 (Woolbrook Dental)
• Vasudev R Garlapaty, MD
• Nancy Lou Garner
• Denise Ruth Gearhart, BA,LBSW
• Joshua David Gelinski
• Steven H Genden, PH.D.
• Eva Gendreau
• Joseph Robert Gendron, RN
• Genoa Healthcare LLC

• Family Nurse Practitioner in Southgate, MI
• Providers in Southgate, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.