Active NPI
Tharackandathil Ooran Shanavas, MD
- Pediatrics Physician
- Adrian, MI
National Provider Identifier
1932158136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- TS034422
- Practice address
- 901 Kimole LN
Suite B-1
Adrian, MI 49221-1491 - Phone
- (517) 263-6733
- Fax
- (517) 263-7148
- NPI assigned
- May 8, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | TS034422 | MI | Primary |
Addresses
Primary practice location
901 Kimole LN
Suite B-1
Adrian, MI 49221-1491
Mailing address
901 Kimole LN
Suite B-1
Adrian, MI 49221-1491
Phone (517) 263-6733
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 350D676100 | Other | MI | BLUE CROSS AND BLUE SHIEL |
| 18632 | Other | MI | HEALTH PLAN OF MI |
| 5450691 | Other | MI | AETNA |
| 03744 | Other | MI | PARAMOUNT |
| 1099349 | Medicaid | MI | |
| 115715 | Other | MI | CARE CHOICE |
| 119775 | Other | MI | GREAT LAKES OF MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TS034422 | MI | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| A. Hajyousef, MD PC | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatrics Physician
- Adrian, MI
- NPI 1841249760
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355184000000",
"number": "1932158136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 KIMOLE LN",
"address_2": "SUITE B-1",
"city": "ADRIAN",
"state": "MI",
"postal_code": "492211491",
"telephone_number": "517-263-6733",
"fax_number": "517-263-7148"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 KIMOLE LN",
"address_2": "SUITE B-1",
"city": "ADRIAN",
"state": "MI",
"postal_code": "492211491",
"telephone_number": "517-263-6733",
"fax_number": "517-263-7148"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANAVAS",
"first_name": "THARACKANDATHIL",
"middle_name": "OORAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-08",
"last_updated": "2012-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "TS034422",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS AND BLUE SHIEL",
"identifier": "350D676100",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PLAN OF MI",
"identifier": "18632",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5450691",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PARAMOUNT",
"identifier": "03744",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1099349",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARE CHOICE",
"identifier": "115715",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GREAT LAKES OF MI",
"identifier": "119775",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Adrian, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.