NPIMap

Individual provider Active NPI

Charles G Godoshian, M.D.

  • Internal Medicine Physician
  • Southfield, MI
National Provider Identifier
1699769190
Registry record updated Nov 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
CG046652 Issued in MI
Practice address
27177 Lahser Rd
Suite 104
Southfield, MI 48034-4714
Phone
(248) 353-0882
Fax
(248) 353-0883
NPI assigned
Sep 12, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 1, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X CG046652 MI Primary

Addresses

Primary practice location

27177 Lahser Rd
Suite 104
Southfield, MI 48034-4714

Mailing address

27177 Lahser Rd
Suite 104
Southfield, MI 48034-4714
Phone (248) 353-0882

Other identifiers 2

IdentifierTypeStateIssuer
1106346941OtherMIBLUE CROSS BLUE SHIELD
1731411MedicaidMI

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
I20050802001202 MI Practitioner - Internal Medicine 8820026990 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Wayne State University School of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Therapy Centers, IncGroup PAC ID 5092605717, 140 clinicians

Practice addresses (Care Compare)

27177 Lahser Rd
Suite 104
Southfield, MI 48034-8467
Phone (248) 353-5296

33010 Northwestern Hwy
West Bloomfield, MI 48322-3634

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
CG046652MIMDInternal Medicine Physician

Interoperability endpoints

  • Direct secure messaging: cgodoshi@direct.dmc.org
  • Direct secure messaging: cgodoshian331772@direct.hfhs.org

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 and National Provider Directory roles.

Hospital & facility affiliations 10

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": "1126483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320105600000",
    "number": "1699769190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27177 LAHSER RD",
            "address_2": "SUITE 104",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480344714",
            "telephone_number": "248-353-0882",
            "fax_number": "248-353-0883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27177 LAHSER RD",
            "address_2": "SUITE 104",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480344714",
            "telephone_number": "248-353-0882",
            "fax_number": "248-353-0883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODOSHIAN",
        "first_name": "CHARLES",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-12",
        "last_updated": "2011-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "CG046652",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1106346941",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1731411",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.