NPIMap

Individual provider Active NPI

Samyuktha R Madishetty I, M.D.

  • Internal Medicine Physician
  • Dearborn, MI
National Provider Identifier
1770650889
Registry record updated Dec 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301080548 Issued in MI
Practice address
24100 Oxford St
Dearborn, MI 48124
Phone
(313) 561-3000
Fax
(313) 561-4831
NPI assigned
Nov 30, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 11, 2020

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 4301080548 MI Primary

Addresses

Primary practice location

24100 Oxford St
Dearborn, MI 48124

Mailing address

24100 Oxford St
Dearborn, MI 48124-2481
Phone (734) 397-3928

Other identifiers 4

IdentifierTypeStateIssuer
1108281851OtherMIBCN IND
1108281851OtherMIBCBS IND
P00470436OtherMIRAILROAD MEDICARE IND PIN
I46399OtherMIHAP

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
I20051207000354 MI Practitioner - Internal Medicine 2668492554 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

24100 Oxford St
Dearborn, MI 48124-2481
Phone (313) 561-3000

Hospital & facility affiliations

  • Beaumont Hospital - Dearborn Hospital, Dearborn, MI, CCN 230020
  • Beaumont Hospital - Taylor Hospital, Taylor, MI, CCN 230270
  • Corewell Health Wayne Hospital Hospital, Wayne, MI, CCN 230142

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301080548MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Samyuktha Rani Madishetty MD PC Internal Medicine CurrentSince Oct 14, 2005 Accepting new patients
Oakwood Healthcare, Inc. Past Accepting new patients
Oakwood Healthcare, Inc. Past Accepting new patients
Cedar Medical Associates Internal Medicine Past Accepting new patients
Oakwood Healthcare, Inc. Past Accepting new patients
Priti Bhardwaj MD PC Internal Medicine PastSince Sep 10, 2004 Accepting new patients

Locations

24100 Oxford St
Dearborn, MI 48124
Phone (313) 274-2500

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JIHFBA

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607644800000",
    "number": "1770650889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24100 OXFORD ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242481",
            "telephone_number": "734-397-3928",
            "fax_number": "313-278-5846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24100 OXFORD ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "48124",
            "telephone_number": "313-561-3000",
            "fax_number": "313-561-4831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADISHETTY",
        "first_name": "SAMYUKTHA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "name_suffix": "I",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-30",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301080548",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN IND",
            "identifier": "1108281851",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS IND",
            "identifier": "1108281851",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE IND PIN",
            "identifier": "P00470436",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAP",
            "identifier": "I46399",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.