Active NPI
Ganesan Sivaguru, O.D.
- Optometrist
- Baileys Crossroads, VA
National Provider Identifier
1043696305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 0618002463
- Practice address
- 3556A S Jefferson St
Baileys Crossroads, VA 22041-3119 - Phone
- (703) 379-1100
- NPI assigned
- Aug 9, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 0618002463 | VA | Primary |
| Corneal and Contact Management Optometrist | 152WC0802X | 0618002463 | VA |
Addresses
Primary practice location
3556A S Jefferson St
Baileys Crossroads, VA 22041-3119
Mailing address
201 Shannon CT
Salisbury, MD 21804-1974
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC, VA, MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 3
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0618002463 | VA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Visionworks, Inc. | Optometrist | Current | Accepting new patients |
| Visionworks, Inc. | Optometrist | Current | Accepting new patients |
| Visionworks, Inc | Current | Accepting new patients | |
| Visionworks, Inc. | Optometrist | Current | Accepting new patients |
| Visionworks Inc. | Past | Accepting new patients |
Locations
169 Jennifer Rd
Ste D
Annapolis, MD 21401
Phone (410) 224-0021
15431 Emerald Way
Bowie, MD 20716
Phone (301) 805-6132
23415 Three Notch Rd
Ste 1101
California, MD 20619
Phone (301) 862-1896
Organizations & group practices 5
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489017600000",
"number": "1043696305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 SHANNON CT",
"city": "SALISBURY",
"state": "MD",
"postal_code": "218041974"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3556A S JEFFERSON ST",
"city": "BAILEYS CROSSROADS",
"state": "VA",
"postal_code": "220413119",
"telephone_number": "703-379-1100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIVAGURU",
"first_name": "GANESAN",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-08-09",
"last_updated": "2017-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "VA",
"license": "0618002463",
"primary": true
},
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "VA",
"license": "0618002463",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baileys Crossroads, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2017; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.