Active NPI
Suhasini S Mistry, M.D.
- Psychiatry Physician
- Livonia, MI
National Provider Identifier
1609831825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- SM047972
- Practice address
- 18420 Farmington Rd
Livonia, MI 48152-3588 - Phone
- (734) 425-5320
- Fax
- (734) 425-6212
- NPI assigned
- Apr 19, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | SM047972 | MI | Primary |
Addresses
Primary practice location
18420 Farmington Rd
Livonia, MI 48152-3588
Mailing address
18420 Farmington Rd
Livonia, MI 48152-3588
Phone (734) 425-5320
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2826930 | Medicaid | MI | |
| OH28401 | Other | MI | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SM047972 | MI | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Amy L. Widenbaum, LMSW, PC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Social Worker
- Farmington Hills, MI
- NPI 1053578179
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398729600000",
"number": "1609831825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18420 FARMINGTON RD",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481523588",
"telephone_number": "734-425-5320",
"fax_number": "734-425-6212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18420 FARMINGTON RD",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481523588",
"telephone_number": "734-425-5320",
"fax_number": "734-425-6212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MISTRY",
"first_name": "SUHASINI",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-04-19",
"last_updated": "2014-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MI",
"license": "SM047972",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2826930",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "OH28401",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Livonia, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.