Active NPI
Pooja Jagdish Mude, DO
- Gastroenterology Physician
- Southfield, MI
National Provider Identifier
1780208892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 5151016492
- Practice address
- 22250 Providence Dr Ste 301a
Southfield, MI 48075-6211 - Phone
- (248) 849-3254
- NPI assigned
- Jun 4, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 5151016492 | MI | Primary |
Addresses
Primary practice location
22250 Providence Dr Ste 301a
Southfield, MI 48075-6211
Mailing address
22250 Providence Dr Ste 301a
Southfield, MI 48075-6211
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5151016492 | MI | MD | Gastroenterology Physician |
| 11872 | GA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688256000000",
"number": "1780208892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22250 PROVIDENCE DR STE 301A",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480756211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22250 PROVIDENCE DR STE 301A",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480756211",
"telephone_number": "248-849-3254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUDE",
"first_name": "POOJA",
"middle_name": "JAGDISH",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-06-04",
"last_updated": "2023-07-02",
"certification_date": "2023-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "MI",
"license": "5151016492",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.