Active NPI
Subhaschandra Reddy Ravi, MD
- General Practice Physician
- Hartford, MI
National Provider Identifier
1043379803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 4301037460
- Practice address
- 30 W Main St
Hartford, MI 49057-1005 - Phone
- (269) 621-2166
- Fax
- (269) 621-2566
- NPI assigned
- Dec 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 4301037460 | MI | Primary |
Addresses
Primary practice location
30 W Main St
Hartford, MI 49057-1005
Mailing address
30 W Main St
Hartford, MI 49057-1005
Phone (269) 621-2166
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3508062072 | Other | MI | BCBS OF MICHIGAN |
| 11286631 | Other | MI | CAQH |
| 1790118 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165449600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043379803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 W MAIN ST",
"city": "HARTFORD",
"state": "MI",
"postal_code": "490571005",
"telephone_number": "269-621-2166",
"fax_number": "269-621-2566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 W MAIN ST",
"city": "HARTFORD",
"state": "MI",
"postal_code": "490571005",
"telephone_number": "269-621-2166",
"fax_number": "269-621-2566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAVI",
"first_name": "SUBHASCHANDRA",
"middle_name": "REDDY",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "MI",
"license": "4301037460",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MICHIGAN",
"identifier": "3508062072",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11286631",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1790118",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hartford, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.