NPIMap

Individual provider Active NPI

Supriya Raina-Hukku, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Detroit, MI
National Provider Identifier
1871795815
Registry record updated May 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
MD60801236 Issued in WA
Practice address
2799 W Grand Blvd
Detroit, MI 48202-2608
Phone
(313) 916-2964
NPI assigned
Jun 1, 2007
Last updated
May 6, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 6, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X MD185514 OR
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 036128898 IL
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 4301088570 MI
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X MD60801236 WA Primary

Addresses

Primary practice location

2799 W Grand Blvd
Detroit, MI 48202-2608

Mailing address

46239 Brookside North Dr
Macomb, MI 48044-5451
Phone (847) 932-9169

Other practice location 1

1498 SE Tech Center Pl Ste 240
Vancouver, WA 98683
Phone (605) 971-3093

Other names 1

  • Dr. Supriya Hukku Professional name

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
I20200413002682 MI Practitioner - PathologyPractitioner - Hematology 2860653276 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
PathologyAlso: Hematology
Education
Wayne State University School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford PathologyGroup PAC ID 6406953439, 47 clinicians
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 916-2600

6777 W Maple Rd
West Bloomfield, MI 48322-3013
Phone (248) 661-4100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036128898ILMDAnatomic Pathology & Clinical Pathology Physician
MD185514ORMDAnatomic Pathology & Clinical Pathology Physician
MD60801236WAMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Macomb Hospital Corporation CurrentSince Mar 1, 2020 Accepting new patients
Henry Ford Health System Single Specialty Current Accepting new patients
Henry Ford Macomb Hospital Corporation Single Specialty Current Accepting new patients
W a Foote Memorial Hospital Inc CurrentSince Mar 1, 2020 Accepting new patients
Henry Ford Health System Single Specialty CurrentSince Mar 1, 2020 Accepting new patients
W.a. Foote Memorial Hospital, Inc CurrentSince Mar 1, 2020 Accepting new patients
Henry Ford Macomb Hospital Corporation Single Specialty CurrentSince Mar 1, 2020 Accepting new patients
W. a. Foote Memorial Hospital, Inc Single Specialty Current Accepting new patients
Henry Ford Pathology Single Specialty CurrentSince Jun 5, 2024 Accepting new patients
Henry Ford Health System CurrentSince Mar 1, 2020 Accepting new patients

Locations

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

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

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

205 N East Ave
Jackson, MI 49201
Phone (517) 788-4730

813 W Michigan Ave
Jackson, MI 49202
Phone (517) 205-1000

6777 W Maple Rd
West Bloomfield, MI 48322
Phone (248) 325-1000

Interoperability endpoints

  • Direct secure messaging: srainahukku631831@direct.hfhs.org

Organizations & group practices 10

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 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": "1180656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588723200000",
    "number": "1871795815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46239 BROOKSIDE NORTH DR",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480445451",
            "telephone_number": "847-932-9169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2799 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022608",
            "telephone_number": "313-916-2964"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1498 SE Tech Center Pl Ste 240",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "98683",
            "country_code": "US",
            "telephone_number": "605-971-3093",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAINA-HUKKU",
        "first_name": "SUPRIYA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-01",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "OR",
            "license": "MD185514",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IL",
            "license": "036128898",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MI",
            "license": "4301088570",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "WA",
            "license": "MD60801236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUPRIYA",
            "last_name": "HUKKU",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.