NPIMap

Individual provider Active NPI

Brad A Shammout, D.O.

  • Diagnostic Radiology Physician
  • Clinton Township, MI
National Provider Identifier
1720067895
Registry record updated Sep 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
5101014470 Issued in MI
Practice address
36175 Harper Ave
Clinton Township, MI 48035-3274
Phone
(586) 741-3772
Fax
(586) 741-4604
NPI assigned
Jan 17, 2006
Last updated
Sep 29, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 5101014470 MI Primary

Addresses

Primary practice location

36175 Harper Ave
Clinton Township, MI 48035-3274

Mailing address

36175 Harper Ave
Clinton Township, MI 48035-3274
Phone (586) 741-3772

Other identifiers 3

IdentifierTypeStateIssuer
0Q26008OtherMIBCBS PROVIDER NUMBER
0H26188OtherMIBCBS PROVIDER NUMBER
4427962MedicaidMI

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
I20040126000121 MI Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 6709788169 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Interventional Radiology
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eastpointe Radiologists PCGroup PAC ID 7618876327, 112 clinicians

Practice addresses (Care Compare)

11800 E 12 Mile Rd
Warren, MI 48093-3472
Phone (586) 573-5000

13350 24 Mile Rd
Suite 200
Shelby Township, MI 48315-1826
Phone (586) 566-8688

17700 23 Mile Rd
Macomb, MI 48044-1154
Phone (586) 416-7530

22101 Moross Rd
Detroit, MI 48236-2148
Phone (313) 343-3248

27351 Dequindre Rd
Madison Heights, MI 48071-3487
Phone (586) 464-0731

4100 River Rd
East China, MI 48054-2909
Phone (810) 329-7111

43900 Garfield Rd
Suite 222
Clinton Township, MI 48038-1137
Phone (586) 286-0050

46591 Romeo Plank Rd
Suite 200
Macomb, MI 48044-5705
Phone (586) 226-6100

64580 Van Dyke Rd
Suite C
Washington, MI 48095-2811
Phone (586) 752-9629

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101014470MIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health St. John Hospital Past Accepting new patients
Open MRI of Michigan Past Accepting new patients
Macomb Magnetic Resonance Imaging Center Inc Diagnostic Radiology Past Accepting new patients
Complete Rehab Services, Inc PastSince Nov 1, 2014 Accepting new patients

Organizations & group practices 5

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 7

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": "1137456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790640000000",
    "number": "1720067895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36175 HARPER AVE",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480353274",
            "telephone_number": "586-741-3772",
            "fax_number": "586-741-4604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36175 HARPER AVE",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480353274",
            "telephone_number": "586-741-3772",
            "fax_number": "586-741-4604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAMMOUT",
        "first_name": "BRAD",
        "middle_name": "A",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-17",
        "last_updated": "2026-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "5101014470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "0Q26008",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "0H26188",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4427962",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton Township, MI

Sources for this page

Verify at the official NPI Registry.