NPIMap

Individual provider Active NPI

Chaitanya Vijay Brundavanam, MD

  • Family Medicine Physician
  • Iron Mountain, MI
National Provider Identifier
1669699211
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301088796 Issued in MI
Practice address
1721 S Stephenson Ave
Iron Mountain, MI 49801-3637
Phone
(906) 776-5316
Fax
(906) 776-5761
NPI assigned
Apr 18, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 4301088796 MI
Family Medicine Physician 207Q00000X 4301088796 MI Primary

Addresses

Primary practice location

1721 S Stephenson Ave
Iron Mountain, MI 49801-3637

Mailing address

1721 S Stephenson Ave
Iron Mountain, MI 49801-3637
Phone (906) 776-5316

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101018000600 MI Practitioner - Family PracticePractitioner - Hospitalist 5799839627 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sound Inpatient Physicians-Michigan PLLCGroup PAC ID 5395896849, 168 clinicians
McLaren Northern MichiganGroup PAC ID 9931018181, 60 clinicians

Practice addresses (Care Compare)

1721 S Stephenson Ave
Dickinson County Healthcare System
Iron Mountain, MI 49801-3637
Phone (906) 774-1313

416 Connable Ave
Petoskey, MI 49770-2212
Phone (231) 487-4000

580 W College Ave
Up Health System
Marquette, MI 49855-2736
Phone (906) 228-9440

Hospital & facility affiliations

  • Marshfield Medical Center Hospital, Iron Mountain, MI, CCN 231342
  • McLaren Northern Michigan Hospital, Petoskey, MI, CCN 230105
  • Dickinson County Memorial Hospital Hospital, Iron Mountain, MI, CCN 230055

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Sound Inpatient Physicians-Michigan, PLLC Family Medicine CurrentSince Aug 1, 2010 Accepting new patients
Apogee Medical Group, Michigan, PC CurrentSince Sep 22, 2016 Accepting new patients
McLaren Northern Michigan Family Medicine CurrentSince Apr 1, 2023 Accepting new patients
Sound Inpatient Physicians - Michigan, PLLC Family Medicine CurrentSince Aug 1, 2010 Accepting new patients
McLaren Northern Michigan CurrentSince Apr 1, 2023 Accepting new patients
Hospitalist Medicine Physicians of Michigan, PLLC CurrentSince Jun 1, 2019 Accepting new patients
Hospitalist Medicine Physicians of Michigan PLLC CurrentSince Jun 1, 2019 Accepting new patients
Dickinson County Healthcare System Past Accepting new patients

Locations

1721 S Stephenson Ave
Iron Mountain, MI 49801
Phone (906) 776-5415

1 Atkinson Dr
Ludington, MI 49431
Phone (231) 843-2591

580 W College Ave
Marquette, MI 49855
Phone (906) 225-3131

850 W Baraga Ave
Marquette, MI 49855
Phone (906) 225-3595

2390 Mitchell Park Dr
Ste D
Petoskey, MI 49770
Phone (231) 242-1760

416 Connable Ave
Petoskey, MI 49770
Phone (231) 487-4000

Organizations & group practices 10

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696377600000",
    "number": "1669699211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 S STEPHENSON AVE",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498013637",
            "telephone_number": "906-776-5316",
            "fax_number": "906-776-5761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 S STEPHENSON AVE",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498013637",
            "telephone_number": "906-776-5316",
            "fax_number": "906-776-5761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNDAVANAM",
        "first_name": "CHAITANYA",
        "middle_name": "VIJAY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-18",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MI",
            "license": "4301088796",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301088796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Iron Mountain, MI

Sources for this page

Verify at the official NPI Registry.