NPIMap

Individual provider Active NPI

Ravindranath V. Kantamneni, M.D.

  • Nephrology Physician
  • Dothan, AL
National Provider Identifier
1053361576
Registry record updated Apr 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
21365 Issued in AL
Practice address
207 Haven Dr
Dothan, AL 36301-2919
Phone
(334) 793-3319
Fax
(334) 793-2291
NPI assigned
May 12, 2006
Last updated
Apr 14, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 14, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 21365 AL Primary

Addresses

Primary practice location

207 Haven Dr
Dothan, AL 36301-2919

Mailing address

207 Haven Dr
Dothan, AL 36301-2919

Other identifiers 2

IdentifierTypeStateIssuer
051076333OtherALBLUE CROSS BLUE SHIELD
000076333MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101004000795 AL Practitioner - Nephrology 3072510445 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
New York Medical College, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dothan Hypertension Nephrology AssociatesGroup PAC ID 5991746661, 11 clinicians

Practice addresses (Care Compare)

207 Haven Dr
Dothan, AL 36301-2919
Phone (334) 793-3319

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
76.88 of 100Reported as individual
Quality
45.49
Improvement activities
40
Cost
69.46

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21365ALMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dothan Hypertension Nephrology Associates CurrentSince Apr 1, 2025 Accepting new patients
Renal Hypertension Clinic Nephrology CurrentSince Dec 1, 1997 Accepting new patients
Dialysis Clinic Inc. CurrentSince Dec 1, 1997 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Locations

1540 E Main St
Dothan, AL 36301
Phone (334) 793-2618

207 Haven Dr
Dothan, AL 36301
Phone (334) 793-1964

3861 Salem Rd
Enterprise, AL 36330
Phone (334) 347-8233

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/1ad2a81d-d102-4f59-a87a-db4fa01056bd/
  • Direct secure messaging: rkantamneni14379@southeasthealth.direct-ci.com
  • Direct secure messaging: rkantamneni42142@direct.davitaphysiciansolutions.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744588800000",
    "number": "1053361576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 HAVEN DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363012919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 HAVEN DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363012919",
            "telephone_number": "334-793-3319",
            "fax_number": "334-793-2291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANTAMNENI",
        "first_name": "RAVINDRANATH",
        "middle_name": "V.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2025-04-14",
        "certification_date": "2025-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "AL",
            "license": "21365",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "051076333",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000076333",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

Verify at the official NPI Registry.