Great Lakes Interventional Pain Management,PLLC

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

License

4301085040 Issued in MI

Legal business name

GREAT LAKES INTERVENTIONAL PAIN MANAGEMENT,PLLC

Practice address

1311 S Linden Rd
Suite a
Flint, MI 48532-3428

Phone

(810) 230-1210

Fax

(810) 230-1225

NPI assigned

Sep 18, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Kavitha Rukkannagari Reddy, M.D.NPI 1174515084

Title

Physician

Phone

(810) 410-5148

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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

• Kavitha R Reddy, MD

  • Physical Medicine & Rehabilitation Physician
  • Flint, MI
  • NPI 1174515084
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1442534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479340800000",
    "number": "1629447719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 S LINDEN RD",
            "address_2": "SUITE A",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323428",
            "telephone_number": "810-230-1210",
            "fax_number": "810-230-1225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 S LINDEN RD",
            "address_2": "SUITE A",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323428",
            "telephone_number": "810-230-1210",
            "fax_number": "810-230-1225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES INTERVENTIONAL PAIN MANAGEMENT,PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-18",
        "last_updated": "2016-11-17",
        "status": "A",
        "authorized_official_last_name": "REDDY",
        "authorized_official_first_name": "KAVITHA",
        "authorized_official_middle_name": "RUKKANNAGARI",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "810-410-5148",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "MI",
            "license": "4301085040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1174515084",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5353030",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaisha Maran Grear
• Great Health Medical Mi PC
• Great Lakes Brain Spine Surgery and Pain Center PLLC
• Great Lakes Chiropractic & Movement PLLC
• Great Lakes Dental Services PLLC
• Great Lakes Oral Surgery and Implants, P.C. (Greater Michigan Oral Surgeons & Dental Implant Center)
• Great Lakes Orthotics and Prosthetics (Great lakes O and P)
• Great Lakes Pain & Rehab, PC
• Great Lakes Recovery Mission
• Great Lakes Recovery Mission, LLC

• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Flint, MI
• Providers in Flint, MI by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.