Adhvith Reddivari, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

28283 Issued in MS

Practice address

5001 Hardy St
Hattiesburg, MS 39402-1308

Phone

(601) 296-3963

NPI assigned

Mar 27, 2018

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

Medicare fee-for-service enrollment

Enrolled in GA

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

Emergency Medicine

Education

Lake Erie College of Osteopathic Medicine, Erie, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sandy Creek Emergency Group, PCGroup PAC ID 3577905520, 44 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Piedmont Fayette Hospital Hospital, Fayetteville, GA, CCN 110215

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Sandy Creek Emergency Group, PC

  • Emergency Medicine Physician
  • Fayetteville, GA
  • NPI 1427817881
  Medicare reassignment Care Compare group NPD
• Walker Lake Emergency Group, PC

  • Emergency Medicine Physician
  • Conyers, GA
  • NPI 1437629342
  Medicare reassignment NPD

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

• Fayette Community Hospital, Inc.

  • General Acute Care Hospital
  • Fayetteville, GA
  • NPI 1528027240
  Care Compare affiliation

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

{
    "created_epoch": "1522108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643068800000",
    "number": "1063917615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10589 WILLOW BROOK RD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454584738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5001 HARDY ST",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021308",
            "telephone_number": "601-296-3963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDDIVARI",
        "first_name": "ADHVITH",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-27",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MS",
            "license": "28283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan H.S. Rayburn, MD
• Raye Medical Management
• Billy Gene Ready Jr., PHD, MA
• Real Life Christian Counseling Center
• Rebecca R Duff, PLLC
• Anjelica Redmond, PCMHT
• Randall Reece, DNP, CRNA
• Dominique Reed Watson, PHARMD
• Ashanti Reed, DNP, CRNA
• Crystal Reeves

• Emergency Medicine Physician in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Emergency Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; 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.