NPIMap

Individual provider Active NPI

Amjad Shidyak, M.D;

  • Internal Medicine Physician
  • Southfield, MI
National Provider Identifier
1902061054
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301097774 Issued in MI
Practice address
28411 Northwestern Hwy
Suite 1050
Southfield, MI 48034-5544
Phone
(248) 354-4709
Fax
(248) 354-4807
NPI assigned
Jul 28, 2008
Last updated
Nov 3, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301097774 MI Primary

Addresses

Primary practice location

28411 Northwestern Hwy
Suite 1050
Southfield, MI 48034-5544

Mailing address

28411 Northwestern Hwy
Suite 1050
Southfield, MI 48034-5544
Phone (248) 354-4709

Other identifiers 2

IdentifierTypeStateIssuer
5315048432OtherMIMI PHARMACY #
4301097774OtherMIMI LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ashidyak13230@epicdirect.promedica.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20141112002354 OH Practitioner - Internal Medicine 7618153867 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Toledo College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Promedica Multi Specialty PhysiciansGroup PAC ID 7113182809, 269 clinicians

Practice addresses (Care Compare)

1250 Ralston Ave
Suite 202
Defiance, OH 43512-5309
Phone (419) 784-2776

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.63 of 100Reported as individual
Quality
82.89
Promoting interoperability
86
Improvement activities
40
Cost
85.97

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301097774MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cogent Healthcare of Michigan PC Internal Medicine Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Defiance Hospital Inc. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: ashidyak13230@direct.promedica.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 9

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": "1217203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1902061054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28411 NORTHWESTERN HWY",
            "address_2": "SUITE 1050",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480345544",
            "telephone_number": "248-354-4709",
            "fax_number": "248-354-4807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28411 NORTHWESTERN HWY",
            "address_2": "SUITE 1050",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480345544",
            "telephone_number": "248-354-4709",
            "fax_number": "248-354-4807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIDYAK",
        "first_name": "AMJAD",
        "credential": "M.D;",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-28",
        "last_updated": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301097774",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI PHARMACY #",
            "identifier": "5315048432",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI LICENSE",
            "identifier": "4301097774",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ashidyak13230@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.