NPIMap

Individual provider Active NPI

Nidhi M Shishu, MD

  • Internal Medicine Physician
  • Beverly Hills, MI
National Provider Identifier
1942280177
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301072368 Issued in MI
Practice address
17392 W 13 Mile Rd
Beverly Hills, MI 48025-5438
Phone
(248) 646-8166
NPI assigned
Jan 23, 2006
Last updated
Feb 10, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

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 4301072368 MI Primary

Addresses

Primary practice location

17392 W 13 Mile Rd
Beverly Hills, MI 48025-5438

Mailing address

26901 Beaumont Blvd Ste 3D
Southfield, MI 48033-3849

Other identifiers 2

IdentifierTypeStateIssuer
080F319020OtherMIBCBS
4542786MedicaidMI

Other names 1

  • Nidhi Devkinandan Gupta Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nshishu12064@direct.beaumont.edu

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
I20110303000875 MI Practitioner - Internal Medicine 4082896568 Reassigns benefits to 1 organization
Practice locations: Bloomfield Hills, MI

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Oakwood Ambulatory LLCGroup PAC ID 1850282914, 271 clinicians

Practice addresses (Care Compare)

17392 W 13 Mile Rd
Corewell Health Internal Medicine
Beverly Hills, MI 48025-5438
Phone (248) 646-8166

201 3Rd St
Suite 200
Belleville, MI 48111-2605
Phone (734) 697-9065

22646 E 9 Mile Rd a
Corewell Health Family Medicine
Saint Clair Shores, MI 48080-1951
Phone (586) 498-4800

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712
Phone (248) 898-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301072368MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oakwood Ambulatory LLC Internal Medicine CurrentSince Nov 15, 2021 Accepting new patients
Oakwood Ambulatory, LLC CurrentSince Nov 15, 2021 Accepting new patients
Nidhi Shishu Internal Medicine CurrentSince Oct 15, 2017 Accepting new patients
William Beaumont Hospital Past Accepting new patients

Locations

201 3rd St
Ste 200
Belleville, MI 48111
Phone (734) 697-9065

17392 W 13 Mile Rd
Beverly Hills, MI 48025
Phone (248) 258-8740

18101 Oakwood Blvd
Dearborn, MI 48124
Phone (313) 593-8780

26901 Beaumont Blvd
Ste 3D
Southfield, MI 48033
Phone (947) 522-1860

10000 Telegraph Rd
Taylor, MI 48180
Phone (313) 295-5000

Interoperability endpoints

  • Direct secure messaging: nshishu12064@direct.beaumont.edu

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644451200000",
    "number": "1942280177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17392 W 13 MILE RD",
            "city": "BEVERLY HILLS",
            "state": "MI",
            "postal_code": "480255438",
            "telephone_number": "248-646-8166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHISHU",
        "first_name": "NIDHI",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-23",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301072368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "080F319020",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4542786",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nshishu12064@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "17392 W 13 Mile Rd",
            "city": "Beverly Hills",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480255438",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "NIDHI",
            "last_name": "GUPTA",
            "middle_name": "DEVKINANDAN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Beverly Hills, MI

Sources for this page

Verify at the official NPI Registry.