NPIMap

Organization Active NPI

Blue Water Children'S Health Care

  • Pediatrics Physician
  • Fort Gratiot, MI
National Provider Identifier
1962003566
Registry record updated Nov 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
BLUE WATER CHILDREN'S HEALTH CARE
Practice address
3030 Commerce Dr
Fort Gratiot, MI 48059-3819
Phone
(810) 385-9559
Fax
(810) 385-9515
NPI assigned
Nov 2, 2020
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Dev Nandamudi, MDNPI 1205802436
Title
MD
Phone
(810) 385-9559

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0987458Blue Water Children'S Health Care, PLLC3030 Commerce Drive, Fort Gratiot, MI 48059Certificate of waiverJun 4, 2027

National Provider Directory

National Provider Directory

Locations

105 Commerce Dr
Brockway, MI 48097
Phone (810) 387-9612

4014 S River Rd
Ste 3B
East China, MI 48054
Phone (810) 329-4779

3030 Commerce Dr
Fort Gratiot, MI 48059
Phone (810) 385-5995

1600 Gratiot Blvd
Ste 8
Marysville, MI 48040

1600 Gratiot Blvd
Ste D
Marysville, MI 48040

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22735/brand/1/csg/1/fhir/r4

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

NPPES NPI Registry

Primary practice location

3030 Commerce Dr
Fort Gratiot, MI 48059-3819

Mailing address

3030 Commerce Dr
Fort Gratiot, MI 48059-3819
Phone (810) 385-9559

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 2, 2020.

{
    "created_epoch": "1604275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604275200000",
    "number": "1962003566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 COMMERCE DR",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593819",
            "telephone_number": "810-385-9559",
            "fax_number": "810-385-9515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 COMMERCE DR",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593819",
            "telephone_number": "810-385-9559",
            "fax_number": "810-385-9515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATER CHILDREN'S HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-02",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A",
        "authorized_official_last_name": "NANDAMUDI",
        "authorized_official_first_name": "DEV",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "810-385-9559",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Gratiot, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.