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SHIVANHALLI PRAKASH MD
NPI 1245343250
Surgery in Clinton Twp, MI

Active since August 16, 2006PECOS EnrolledAccepts Medicare Assignment
43311 COMMONS DR, CLINTON TWP, MI 48038(586) 263-8555(586) 263-8558 Get Directions Write a Review

NPPES record last updated: October 30, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Shivanhalli Prakash Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHIVANHALLI PRAKASH MD (NPI 1245343250) is an individual surgery provider in Clinton Twp, Michigan, licensed in Michigan (SP407447) and active in the NPI registry since August 2006. He is enrolled in Medicare PECOS, is affiliated with Henry Ford Macomb Hospital, and is a graduate of Other (1973).

NPPES Registry Identity

NPI1245343250
Entity TypeIndividualMale
Primary Taxonomy208600000X
Provider Legal NameSHIVANHALLI PRAKASHCredential: MD
Location Address43311 COMMONS DRClinton Twp, MI 48038-1109
Mailing Address43311 Commons DriveClinton Township, MI 48038-1109 · (586) 263-8555 · Fax (586) 263-8558
Phone(586) 263-8555
Fax(586) 263-8558
Sole ProprietorNo
Medical School CMSOtherGraduated 1973
Enumeration DateAugust 16, 2006
Last NPPES UpdateOctober 30, 2024
NPPES CertifiedOctober 30, 2024
✔ NPI 1245343250 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208600000X
License✔ Licensed in MI · SP407447
Definition
A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.
43311 COMMONS DR, Clinton Twp, MI 48038
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Other Names 1

Other Name (5)Shivana Prakash Md

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Shivanhalli Prakash Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8820012495
PECOS Enrollment IDI20060126000137
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

3

Medicare enrollment records show Shivanhalli Prakash reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Shivana N. Prakash Mdpc
Same address
Surgery
43311 COMMONS DR
Clinton Twp, MI 48038
  • Reassigned Medicare billing, Michigan enrollment
NPI 1457409971 (586) 263-8555
Henry Ford Macomb Hospital Corporation
0.1 mi
Physician Assistant
15855 19 MILE RD
Clinton Twp, MI 48038
  • Reassigned Medicare billing, Michigan enrollment
  • 556 clinicians in this Medicare group
NPI 1124421888 (800) 532-2411
Pioneer Medical Associates P.C.
0.3 mi
Internal Medicine
15945 19 MILE RD STE 204
Clinton Twp, MI 48038
  • Reassigned Medicare billing, Michigan enrollment
  • Medicare enrollment name: Pioneer Medical Associates PC
  • 28 clinicians in this Medicare group
NPI 1093296592 (586) 757-6400

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes 99231
Follow-up hospital inpatient care is a daily service where a healthcare professional checks on your health progress during your hospital stay. Each session typically lasts 15 minutes, involving updates on your condition and adjustments to your treatment plan, if necessary.
113 services56 patients
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222
Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.
85 services81 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
69 services50 patients
Emergency department visit with moderate level of medical decision making 99284
An emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.
59 services58 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
28 services28 patients
Hospital discharge day management, 30 minutes or less 99238
Hospital discharge day management of 30 minutes or less includes finalizing your treatment, discussing your progress, and planning after-care at home. It ensures you're ready to leave the hospital and continue recovery safely.
26 services26 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Henry Ford Macomb Hospital

Acute Care Hospitals · Clinton Township, MI
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number230047
Location15855 Nineteen Mile RdClinton Township, MI 48038 · Macomb County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 48038 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$90.76 typical visit price
range $58.04 – $177.36
Typical copayment $22.69 (range $14.51 – $44.34)
Most-billed visit code 99203
Established Patient
$72.38 typical visit price
range $18.32 – $143.49
Typical copayment $18.09 (range $4.58 – $35.87)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

Reported Quality Measures

Breast Cancer Screening
Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer
59%99 patients3/55-star benchmark: 92%
Cervical Cancer Screening
Percentage of women 21-64 years of age who were screened for cervical cancer using either of the following criteria: - Women age 21-64 who had cervical cytology performed every 3 years - Women age 30-64 who had cervical cytology/human papillomavirus (HPV)…
41%115 patients
Closing the Referral Loop: Receipt of Specialist Report
Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred
2%62 patients1/55-star benchmark: 95%
Colorectal Cancer Screening
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
58%226 patients3/55-star benchmark: 85%
Diabetes: Eye Exam
Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period
5%64 patients1/55-star benchmark: 100%
Diabetes: Foot Exam
The percentage of patients 18-75 years of age with diabetes (type 1 and type 2) who received a foot exam (visual inspection and sensory exam with mono filament and a pulse exam) during the measurement year
41%64 patients2/55-star benchmark: 98%
Diabetes: Medical Attention for Nephropathy
The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period
95%64 patients4/55-star benchmark: 99%
Documentation of Current Medications in the Medical Record
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.
93%1,377 patients4/55-star benchmark: 100%
Falls: Screening for Future Fall Risk
Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period
51%142 patients3/55-star benchmark: 99%
Medication Reconciliation
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
100%794 patients5/55-star benchmark: 100%
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
100%673 patients5/55-star benchmark: 97%
Pneumococcal Vaccination Status for Older Adults
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
41%150 patients2/55-star benchmark: 90%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…
50%487 patients3/55-star benchmark: 97%
Preventive Care and Screening: Influenza Immunization
Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization
33%315 patients2/55-star benchmark: 88%
Preventive Care and Screening: Screening for Depression and Follow-Up Plan
Percentage of patients aged 12 years and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen
43%412 patients2/55-star benchmark: 96%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Patients screenedForUse: 99% · 117 patients
Patients tobacco: 92% · 117 patients
68%25 patients3/55-star benchmark: 98%
Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
100%673 patients5/55-star benchmark: 100%
Secure Messaging
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…
29%673 patients2/55-star benchmark: 89%
Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period: - Adults aged >= 21 years who were previously diagnosed with or currently have an active…
71%171 patients4/55-star benchmark: 89%
Use of High-Risk Medications in the Elderly
Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication.
Lower rates are better for this measure.
Patients 2+: 0% · 150 patients
1%150 patients4/55-star benchmark: 100%
View, Download, or Transmit (VDT)
At least one patient seen by the MIPS eligible clinician during the performance period (or patient-authorized representative) views, downloads or transmits their health information to a third party during the performance period.
40%673 patients
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 4

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each A4385
DME-Orthotic Devices · category DF010N
3 suppliers14 claims210 services$4.68 avg. paid by Medicare
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each A4409
DME-Orthotic Devices · category DF010N
1 supplier11 claims110 services$5.45 avg. paid by Medicare
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each A5063
DME-Orthotic Devices · category DF010N
1 supplier11 claims110 services$2.37 avg. paid by Medicare
Skin barrier, wipes or swabs, each A5120
DME-Orthotic Devices · category DF010N
5 suppliers21 claims1,150 services$0.22 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SHIVANA N. PRAKASH MDPC
Surgery
43311 COMMONS DR
CLINTON TWP, MI 48038
Macomb County (586) 263-8555

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shivanhalli Prakash's NPI number?

The NPI number for Shivanhalli Prakash is 1245343250. It was assigned to this individual provider in the NPPES registry on August 16, 2006. The provider is also known as Shivana Prakash MD.

Where is Shivanhalli Prakash located?

Shivanhalli Prakash practices at 43311 Commons Dr, Clinton Twp, MI 48038. The listed phone number is (586) 263-8555.

What is Shivanhalli Prakash's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Is Shivanhalli Prakash enrolled in Medicare?

Yes. Shivanhalli Prakash is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Shivanhalli Prakash's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Shivanhalli Prakash reassigns Medicare benefits to 3 organizations: Shivana N. Prakash Mdpc (Clinton Twp, MI), Henry Ford Macomb Hospital Corporation (Clinton Twp, MI) and Pioneer Medical Associates P.C. (Clinton Twp, MI). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Shivanhalli Prakash's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Shivanhalli Prakash accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company and 1 other insurer list Shivanhalli Prakash as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Shivanhalli Prakash affiliated with any hospitals?

According to CMS data, Shivanhalli Prakash is affiliated with Henry Ford Macomb Hospital.

When was this NPI record last updated?

The NPPES record for Shivanhalli Prakash was last updated on October 30, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.