Visala Dandamudi, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

4301080937 Issued in MI

Practice address

25869 Kelly Rd
Suite a
Roseville, MI 48066-4997

Phone

(586) 773-6020

Fax

(586) 773-6093

NPI assigned

Jun 29, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Psychiatry

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Henry Ford Health Brighton Center for RecoveryGroup PAC ID 2668466996, 15 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Henry Ford Health Brighton Center for Recovery Hospital, Brighton, MI, CCN 230279

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Henry Ford Health Brighton Center for Recovery

  • Substance Abuse Rehabilitation Facility
  • Brighton, MI
  • NPI 1265527337
  Medicare reassignment Care Compare group NPD
• Biological Psychiatry Center, PC

  • Clinical Social Worker
  • Roseville, MI
  • NPI 1649510819

  Psychiatry

  NPD (past)

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

• Henry Ford Health Brighton Center for Recovery

  • Substance Abuse Rehabilitation Facility
  • Brighton, MI
  • NPI 1265527337

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207008000000",
    "number": "1982632691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25869 KELLY RD",
            "address_2": "SUITE A",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664997",
            "telephone_number": "586-773-6020",
            "fax_number": "586-773-6093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25869 KELLY RD",
            "address_2": "SUITE A",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664997",
            "telephone_number": "586-773-6020",
            "fax_number": "586-773-6093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANDAMUDI",
        "first_name": "VISALA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-29",
        "last_updated": "2008-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301080937",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4658039",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul A Cullis, MD
• Edward R Dabrowski, M.D.
• Dale J Kretunski D.C, P.C.
• Dale J Kretunski DC PC
• Dallah Medcare Services, Inc.
• Daniel a Lepri, DDS PC
• Peter Daniel
• David a. Susko, DDS
• David M Zalenski MD PLLC
• Bronwyn Marea Davis, MA, LPC

• Psychiatry Physician in Roseville, MI
• Providers in Roseville, MI by specialty
• Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2008; 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.