Organization Active NPI

R.R. Yalamanchi, M.D. P.C.

  • Internal Medicine Physician
  • Southgate, MI
National Provider Identifier
1629335195
Registry record updated Apr 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
R.R. YALAMANCHI, M.D. P.C.
Practice address
13300 Northline Rd
Southgate, MI 48195-1065
Phone
(734) 282-7353
Fax
(734) 282-8178
NPI assigned
Apr 20, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2012

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

Authorized official

Name
Dr. R R Yalamanchi, M.D.
Title
Owner
Phone
(734) 282-7353

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

13300 Northline Rd
Southgate, MI 48195-1065

Mailing address

13300 Northline Rd
Southgate, MI 48195-1065
Phone (734) 282-7353

Other identifiers 1

IdentifierTypeStateIssuer
2102832MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120516000433 MI Part B Supplier - Clinic/Group Practice 6103089818 Receives reassigned benefits from 2 practitioners
Practice locations: Southgate, MI

National Provider Directory

National Provider Directory

Locations

13300 Northline Rd
Southgate, MI 48195
Phone (313) 282-7353

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1334880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334880000000",
    "number": "1629335195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13300 NORTHLINE RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481951065",
            "telephone_number": "734-282-7353",
            "fax_number": "734-282-8178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13300 NORTHLINE RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481951065",
            "telephone_number": "734-282-7353",
            "fax_number": "734-282-8178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R.R. YALAMANCHI, M.D. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-20",
        "last_updated": "2012-04-20",
        "status": "A",
        "authorized_official_last_name": "YALAMANCHI",
        "authorized_official_first_name": "R",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-282-7353",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2102832",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southgate, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2012; 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.