Active NPI
Pavan Kumar Gorukanti, M.D.
- Internal Medicine Physician
- Harvey, MI
National Provider Identifier
1629208392
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 4301094183
- Practice address
- 170 Bayou St
Harvey, MI 49855-9101 - Phone
- (517) 974-8055
- Fax
- (517) 432-3145
- NPI assigned
- Jul 16, 2009
- Last updated
- May 30, 2017
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 4301094183 | MI | Primary |
Addresses
Primary practice location
170 Bayou St
Harvey, MI 49855-9101
Mailing address
1414 W Fair Ave
Ste 211
Marquette, MI 49855-5406
Phone (906) 225-3912
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629208392 | Medicaid | MI |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edward W. Sparrow Hospital Association | Past | Accepting new patients | |
| Edward W Sparrow Hospital Association | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba University of Michigan Health-Sparrow
- Adult Health Nurse Practitioner
- Lansing, MI
- NPI 1265220438
-
dba Sparrow Medical Group Hospitalist
- Hospitalist Physician
- Lansing, MI
- NPI 1164478822
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1496102400000",
"number": "1629208392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1414 W FAIR AVE",
"address_2": "STE 211",
"city": "MARQUETTE",
"state": "MI",
"postal_code": "498555406",
"telephone_number": "906-225-3912",
"fax_number": "906-225-7538"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "170 BAYOU ST",
"city": "HARVEY",
"state": "MI",
"postal_code": "498559101",
"telephone_number": "517-974-8055",
"fax_number": "517-432-3145"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORUKANTI",
"first_name": "PAVAN",
"middle_name": "KUMAR",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-16",
"last_updated": "2017-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "4301094183",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1629208392",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Harvey, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.