SHIVANI V KONDAGUNTA (PA-C) – Physician Assistant, NPI 1306735311
Physician Assistant
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
6,069 PHYSICIAN ASSISTANT in MI
Provider Addresses for SHIVANI V KONDAGUNTA (PA-C)
5300 Elliott Dr
Ypsilanti, MI 481978632
Phone: (734) 434-6262
Fax: (734) 712-2820
Type: Location
5300 ELLIOTT DR
YPSILANTI, MI 481978632
Phone: (734) 434-6262
Fax: (734) 712-2820
Type: Mailing
259 MACK AVE
DETROIT, MI 482012427
Phone: (313) 577-1716
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-12-04
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20251204000820 | I | Physician Assistant | MI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 48197)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Certified Registered Nurse Anesthetist (Crna) | MI | |
| Physician Assistant | MI | |
| Nurse Practitioner | ID | |
| Certified Registered Nurse Anesthetist (Crna) | MI | |
| G A S T R O E N T E R O L O G Y | MI | |
| G A S T R O E N T E R O L O G Y | MI | |
| Anesthesiology, Interventional Pain Management | MI | |
| Physician Assistant | MI | |
| Clinical Social Worker | MI | |
| Certified Registered Nurse Anesthetist (Crna) | MI |
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