NPIMap

Individual provider Active NPI

Jitendra P Katneni, MD

  • Internal Medicine Physician
  • Flint, MI
National Provider Identifier
1710949813
Registry record updated Jul 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301051876 Issued in MI
Practice address
1170 Charter Dr
Suite a
Flint, MI 48532-3587
Phone
(810) 733-5000
Fax
(810) 733-5284
NPI assigned
Apr 4, 2006
Last updated
Jul 1, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 1, 2016

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 4301051876 MI Primary

Addresses

Primary practice location

1170 Charter Dr
Suite a
Flint, MI 48532-3587

Mailing address

8359 Office Park Dr
Grand Blanc, MI 48439-2078
Phone (810) 733-5000

Other identifiers 1

IdentifierTypeStateIssuer
2672861MedicaidMI

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
I20070418000083 MI Practitioner - Internal MedicinePractitioner - Geriatric Medicine 5890698054 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Other, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hurley Medical CenterGroup PAC ID 2961308481, 336 clinicians

Practice addresses (Care Compare)

1 Hurley Plasa
9W Hurley Maternal Fetal Medicine
Flint, MI 48503-5902
Phone (810) 262-4787

1 Hurley PLZ
Flint, MI 48503-5902

1170 Charter Dr
Flint, MI 48532-3587
Phone (810) 733-5000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Hurley Medical Center Internal Medicine CurrentSince Mar 2, 2009 Accepting new patients
Hurley Medical Center CurrentSince Mar 2, 2009 Accepting new patients
Hurley Medical Center Current Accepting new patients
Hurley Medical Center Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

4272 W Vienna Rd
Clio, MI 48420
Phone (810) 687-2850

1 Hurley Plz
Flint, MI 48503
Phone (810) 257-9000

1125 S Linden Rd
Ste 210
Flint, MI 48532
Phone (810) 230-3370

Organizations & group practices 6

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.

Hospital & facility affiliations 6

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": "1144108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467331200000",
    "number": "1710949813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8359 OFFICE PARK DR",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484392078",
            "telephone_number": "810-733-5000",
            "fax_number": "810-733-5284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1170 CHARTER DR",
            "address_2": "SUITE A",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323587",
            "telephone_number": "810-733-5000",
            "fax_number": "810-733-5284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KATNENI",
        "first_name": "JITENDRA",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-04",
        "last_updated": "2016-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301051876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2672861",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flint, MI

Sources for this page

Verify at the official NPI Registry.