Individual provider Active NPI

Pavan Somusetty, M.D.

  • Psychiatry Physician
  • Dayton, OH
National Provider Identifier
1033317136
Registry record updated Jul 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
57.010933 Issued in OH
Practice address
2222 Philadelphia Dr
Dayton, OH 45406-1813
Phone
(937) 278-2612
NPI assigned
Jul 10, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 10, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 57.010933 OH Primary

Addresses

Primary practice location

2222 Philadelphia Dr
Dayton, OH 45406-1813

Mailing address

1687 Big Bear Drive
Centerville, OH 45458

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20100615000204 OR Practitioner - Psychiatry 6305976572 Reassigns benefits to 1 organization
I20210419001250 WA Practitioner - Psychiatry 6305976572 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
57.010933OHMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Mar 26, 2010 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Jan 5, 2021 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Mar 26, 2010 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Current Accepting new patients

Locations

10163 SE Sunnyside Rd
Ste 490
Clackamas, OR 97015
Phone (503) 513-4400

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184025600000",
    "number": "1033317136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1687 BIG BEAR DRIVE",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "45458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 PHILADELPHIA DR",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454061813",
            "telephone_number": "937-278-2612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOMUSETTY",
        "first_name": "PAVAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-10",
        "last_updated": "2007-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OH",
            "license": "57.010933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.