Srinivasa Raghavan Madhavan, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

13694 Issued in ND

Practice address

801 Broadway N
Fargo, ND 58102-3641

Phone

(701) 234-5933

NPI assigned

Jul 31, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Internal Medicine

Education

University of North Dakota School of Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baylor Scott & White Medical Center - Centennial Hospital, Frisco, TX, CCN 450885

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Healthtexas Provider Network

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1760488936
  Medicare reassignment Care Compare group NPD
• Healthtexas Provider Network

  • Family Medicine Physician
  • Plano, TX
  • NPI 1003811639
  NPD
• Healthtexas Provider Network

  • Anesthesiology Physician
  • Lakeway, TX
  • NPI 1104714583
  NPD
• Baylor Scott & White Medical Center - Centennial

  • General Acute Care Hospital
  • Frisco, TX
  • NPI 1801826839
  NPD (past)

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

• Baylor Scott & White Medical Center - Centennial

  • General Acute Care Hospital
  • Frisco, TX
  • NPI 1801826839
  Care Compare affiliation

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

{
    "created_epoch": "1343692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687219200000",
    "number": "1043566607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2168",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581072168",
            "telephone_number": "701-234-2119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581023641",
            "telephone_number": "701-234-5933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADHAVAN",
        "first_name": "SRINIVASA",
        "middle_name": "RAGHAVAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-31",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "ND",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ND",
            "license": "13694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smadhavan460850@direct.sw.org",
            "affiliation": "N",
            "address_1": "12505 Lebanon Rd Ste 1442",
            "city": "Frisco",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750358298",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Robert D Mack, DDS
• Amanda Marie Mackner, OD
• Nicholas Mackner
• Sherie Kay Madewell-Buesgens, LCSW
• Hussein Abuker Madey
• John Charles Madison III, MD
• Sarah Madison
• Tamara Marie Madler, LCSW, LAC, LICSW
• Jackie L Madsen, DPT
• Jeffrey D Madsen, LAPC

• Internal Medicine Physician in Fargo, ND
• Providers in Fargo, ND by specialty
• Internal Medicine Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; 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.