Gayathri N Manickam, M.D.

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

4301085440 Issued in MI

Practice address

4401 Conner St
Detroit, MI 48215-2201

Phone

(313) 823-9800

NPI assigned

May 23, 2007

Last updated

Nov 3, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Sports MedicineAlso: Family Practice

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053
• Henry Ford Macomb Hospital Hospital, Clinton Township, MI, CCN 230047

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gmanickam13633@direct.hfhs.org

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.

• Henry Ford Health System

  • General Acute Care Hospital
  • Detroit, MI
  • NPI 1134144801
  Medicare reassignment Care Compare group NPD
• Henr Y Ford Health System

  • Orthopaedic Surgery Physician
  • Detroit, MI
  • NPI 1700960036
  NPD
• Henry Ford Health System

  • Community/Retail Pharmacy
  • Plymouth, MI
  • NPI 1942931720
  NPD
• Henr Y Ford Health System

  • Family Medicine Physician
  • Detroit, MI
  • NPI 1952485351
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Henry Ford Health System

  • General Acute Care Hospital
  • Detroit, MI
  • NPI 1134144801
  Care Compare affiliation
• Henry Ford Macomb Hospital Corporation

  dba Henry Ford Health Macomb Hospital

  • General Acute Care Hospital
  • Clinton TWP, MI
  • NPI 1023114634
  Care Compare affiliation
• Henry Ford Macomb Hospital Corporation

  • General Acute Care Hospital
  • Warren, MI
  • NPI 1902842735
  Care Compare affiliation

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1932319753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2852 BIRCHDALE DR",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480836809",
            "telephone_number": "720-771-7792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 CONNER ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482152201",
            "telephone_number": "313-823-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANICKAM",
        "first_name": "GAYATHRI",
        "middle_name": "N",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-23",
        "last_updated": "2023-11-03",
        "certification_date": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301085440",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MI",
            "license": "4301085440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Manely Yours LLC
• Aaron Manenti, MD, MPH
• Ruchi Mangal, MD
• Brian Mangenje, FNP-BC
• Janaki Manian, M.D.
• Manifest Thirty-One LLC
• Kitty Lynn Manire
• Ahila Manivannan, MD
• Suzanne H Manji, RN
• Victoria J Manley, RN

• Sports Medicine (Family Medicine) Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Sports Medicine (Family Medicine) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.