Individual provider Active NPI

Soumya Venkata Panchagnula

  • Family Medicine Physician
  • Warren, MI
National Provider Identifier
1770740045
Registry record updated Apr 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301090433 Issued in MI
Practice address
8600 Chicago Rd
Warren, MI 48093-5546
Phone
(586) 826-3300
NPI assigned
May 22, 2008
Last updated
Apr 1, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301090433 MI Primary

Addresses

Primary practice location

8600 Chicago Rd
Warren, MI 48093-5546

Mailing address

8600 Chicago Rd
Warren, MI 48093-5546
Phone (586) 826-3300

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address spanchagnula13979@hfhs.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110926000074 MI Practitioner - Family Practice 7315118247 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

8600 Chicago Rd
Warren, MI 48093-5546
Phone (586) 826-3300

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301090433MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health System Current Accepting new patients
Henry Ford Health System CurrentSince Aug 22, 2011 Accepting new patients
Henr Y Ford Health System Family Medicine CurrentSince Aug 22, 2011 Accepting new patients
Henry Ford Maplegrove Center Past Accepting new patients

Locations

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

8600 Chicago Rd
Warren, MI 48093
Phone (586) 826-3300

Interoperability endpoints

  • Direct secure messaging: spanchagnula13979@direct.hfhs.org

Organizations & group practices 4

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 3

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": "1211414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617235200000",
    "number": "1770740045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8600 CHICAGO RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480935546",
            "telephone_number": "586-826-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8600 CHICAGO RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480935546",
            "telephone_number": "586-826-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANCHAGNULA",
        "first_name": "SOUMYA",
        "middle_name": "VENKATA",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-22",
        "last_updated": "2021-04-01",
        "certification_date": "2021-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301090433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "spanchagnula13979@hfhs.org",
            "affiliation": "N",
            "address_1": "8600 Chicago Rd",
            "city": "Warren",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480935546",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

Verify at the official NPI Registry.