Individual provider Active NPI

Vinod K Misra, MD PHD

  • Clinical Genetics (M.D.) Physician
  • Detroit, MI
National Provider Identifier
1861402497
Registry record updated Oct 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Genetics (M.D.) PhysicianTaxonomy code 207SG0201X
License
4301079084 Issued in MI
Practice address
3950 Beaubien St
Detroit, MI 48201-2120
Phone
(734) 832-9122
NPI assigned
Aug 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Genetics (M.D.) Physician 207SG0201X 4301079084 MI Primary
Pediatrics Physician 208000000X 4301079084 MI

Addresses

Primary practice location

3950 Beaubien St
Detroit, MI 48201-2120

Mailing address

3950 Beaubien St
Detroit, MI 48201-2120
Phone (734) 832-9122

Other identifiers 1

IdentifierTypeStateIssuer
4572490MedicaidMI

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
I20040308000624 MI Practitioner - Pediatric Medicine 2365330735 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Columbia University College of Physicians and Surgeons, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University PediatriciansGroup PAC ID 9638070568, 121 clinicians

Practice addresses (Care Compare)

3901 Beaubien St
Detroit, MI 48201-2119
Phone (313) 745-5870

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University Pediatricians Pediatrics CurrentSince Jul 1, 2010 Accepting new patients
University Pediatricians Pediatrics CurrentSince Jul 1, 2010 Accepting new patients

Locations

3950 Beaubien St
Detroit, MI 48201
Phone (313) 745-5437

3901 Beaubien St
Detroit, MI 48201
Phone (313) 745-5227

3950 Beaubien St
Fl 3
Detroit, MI 48201
Phone (313) 832-9220

3901 Beaubien St
Fl 3
Detroit, MI 48201
Phone (313) 745-5906

Interoperability endpoints

  • Direct secure messaging: vmisra@direct.dmc.org

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349049600000",
    "number": "1861402497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3950 BEAUBIEN ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012120",
            "telephone_number": "734-832-9122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 BEAUBIEN ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012120",
            "telephone_number": "734-832-9122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISRA",
        "first_name": "VINOD",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2012-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207SG0201X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Clinical Genetics (M.D.)",
            "state": "MI",
            "license": "4301079084",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301079084",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4572490",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.