NPIMap

Individual provider Active NPI

Sotirios Peter Kalliantasis, DO

  • Family Medicine Physician
  • Clinton Township, MI
National Provider Identifier
1780244483
Registry record updated Apr 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5151013930 Issued in MI
Practice address
15855 19 Mile Rd
Clinton Township, MI 48038-3504
Phone
(586) 201-0987
NPI assigned
Jun 17, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 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 5151013930 MI Primary

Addresses

Primary practice location

15855 19 Mile Rd
Clinton Township, MI 48038-3504

Mailing address

15855 19 Mile Rd
Clinton Township, MI 48038-3504
Phone (586) 201-0987

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address skalliantasis548212@direct.hfhs.org

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
I20220524000262 MI Practitioner - Family Practice 7214262484 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Physician PartnersGroup PAC ID 8921482605, 79 clinicians

Practice addresses (Care Compare)

43421 Garfield Rd
Suite 1
Clinton TWP, MI 48038-1133
Phone (586) 286-5500

Hospital & facility affiliations

  • Henry Ford Home Health Care Home health agency, Detroit, MI, CCN 237087
  • Optimal Care Home Health Home health agency, Bingham Farms, MI, CCN 237504
  • Henry Ford Macomb Hospital Hospital, Clinton Township, MI, CCN 230047
  • Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053
  • Henry Ford Health St John Hospital Hospital, Detroit, MI, CCN 230165

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 Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Physician Partners Family Medicine CurrentSince Sep 1, 2022 Accepting new patients
Internal Medicine Associates of Mt. Clemens, PC Current Accepting new patients
Henry Ford Macomb Ancillary Services Current Accepting new patients
Alliance Health Professionals, PLLC CurrentSince Jul 1, 2022 Accepting new patients
Henry Ford Physician Partners CurrentSince Sep 1, 2022 Accepting new patients

Locations

2689 Solution Ctr
Chicago, IL 60677

15855 19 Mile Rd
Clinton Twp, MI 48038
Phone (586) 263-2300

43421 Garfield Rd
Ste 1
Clinton Twp, MI 48038
Phone (586) 286-5500

133 S Main St
Mount Clemens, MI 48043
Phone (586) 329-1880

Interoperability endpoints

  • Direct secure messaging: skalliantasis548212@direct.hfhs.org

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1560729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618185600000",
    "number": "1780244483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15855 19 MILE RD",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480383504",
            "telephone_number": "586-201-0987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15855 19 MILE RD",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480383504",
            "telephone_number": "586-201-0987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALLIANTASIS",
        "first_name": "SOTIRIOS",
        "middle_name": "PETER",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-17",
        "last_updated": "2021-04-12",
        "certification_date": "2021-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5151013930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "skalliantasis548212@direct.hfhs.org",
            "affiliation": "N",
            "address_1": "15855 19 Mile Rd",
            "city": "Clinton Township",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480383504",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Clinton Township, MI

Sources for this page

Verify at the official NPI Registry.