NPIMap

Individual provider Active NPI

Shyam Sunder Moudgil, MD

  • Neurology Physician
  • Roseville, MI
National Provider Identifier
1740390848
Registry record updated Mar 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
4301069080 Issued in MI
Practice address
25195 Kelly Rd
Suite B
Roseville, MI 48066-4909
Phone
(586) 777-3370
Fax
(586) 777-3380
NPI assigned
Aug 30, 2006
Last updated
Mar 2, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301069080 MI
Neurology Physician 2084N0400X 4301069080 MI Primary

Addresses

Primary practice location

25195 Kelly Rd
Suite B
Roseville, MI 48066-4909

Mailing address

25195 Kelly Rd
Suite B
Roseville, MI 48066-4909
Phone (586) 777-3370

Other identifiers 1

IdentifierTypeStateIssuer
4399330MedicaidMI

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
I20120524000335 MI Practitioner - Neurology 3476716770 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
West Virginia University School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Semi Medical GroupGroup PAC ID 0648180406, shared by 4 NPIs, 246 clinicians
Lakeside Neurology P CGroup PAC ID 0648233353, 2 clinicians

Practice addresses (Care Compare)

17900 23 Mile Rd
Macomb, MI 48044-1161
Phone (313) 647-3900

28573 Schoenherr Rd
Warren, MI 48088-4330
Phone (586) 777-3375

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.82 of 100Reported as group
Quality
74.48
Promoting interoperability
100
Improvement activities
40
Cost
64.33

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301069080MIMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeside Neurology P C Neurology CurrentSince Jul 1, 2002 Accepting new patients
Henry Ford Health St. John Hospital Past Accepting new patients
Allergy Clinic of Warren PC Past Accepting new patients

Locations

25195 Kelly Rd
Ste B
Roseville, MI 48066
Phone (586) 777-3370

28573 Schoenherr Rd
Warren, MI 48088
Phone (586) 558-5700

Interoperability endpoints

  • Direct secure messaging: smoudgil63283@direct.hfhs.org

Organizations & group practices 3

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488412800000",
    "number": "1740390848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25195 KELLY RD",
            "address_2": "SUITE B",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664909",
            "telephone_number": "586-777-3370",
            "fax_number": "586-777-3380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25195 KELLY RD",
            "address_2": "SUITE B",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664909",
            "telephone_number": "586-777-3370",
            "fax_number": "586-777-3380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUDGIL",
        "first_name": "SHYAM",
        "middle_name": "SUNDER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2017-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301069080",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301069080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4399330",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MI

Sources for this page

Verify at the official NPI Registry.