Individual provider Active NPI

Phani Deepthi Vadlamudi, M.D.

  • Family Medicine Physician
  • Harrison, MI
National Provider Identifier
1932426293
Registry record updated Jul 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301103017 Issued in MI
Practice address
815 N Clare Ave
Harrison, MI 48625-9194
Phone
(989) 539-5261
NPI assigned
Apr 27, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301103017 MI Primary
Family Medicine Physician 207Q00000X 27761 OK

Addresses

Primary practice location

815 N Clare Ave
Harrison, MI 48625-9194

Mailing address

815 N Clare Ave
Harrison, MI 48625-9194
Phone (989) 539-5261

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
I20130906000749 MI Practitioner - Family Practice 2567605702 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mymichigan Medical Center ClareGroup PAC ID 7012829773, 128 clinicians

Practice addresses (Care Compare)

815 N Clare Ave
Suite a
Harrison, MI 48625-8177
Phone (989) 539-4434

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301103017MIMDFamily Medicine Physician
27761OKMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mymichigan Medical Center Clare CurrentSince Jul 8, 2013 Accepting new patients
Mymichigan Medical Center Clare Past Accepting new patients

Locations

602 Beech St
Ste 1100
Clare, MI 48617
Phone (989) 386-9911

815 N Clare Ave
Ste A
Harrison, MI 48625
Phone (989) 539-4434

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

Interoperability endpoints

  • Direct secure messaging: pvadlamudi7030@mymichiganhealth.midirect.net

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, 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": "1272326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374710400000",
    "number": "1932426293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 N CLARE AVE",
            "city": "HARRISON",
            "state": "MI",
            "postal_code": "486259194",
            "telephone_number": "989-539-5261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 N CLARE AVE",
            "city": "HARRISON",
            "state": "MI",
            "postal_code": "486259194",
            "telephone_number": "989-539-5261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VADLAMUDI",
        "first_name": "PHANI DEEPTHI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-27",
        "last_updated": "2013-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301103017",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "27761",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrison, MI

Sources for this page

Verify at the official NPI Registry.