Mabbu Gajapathy Shivaprasad, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35-072257 Issued in OH

Practice address

Logan Family Medical Center LLC
2210 Timber Trail
Bellefontaine, OH 43311

Phone

(937) 593-3151

Fax

(937) 593-5438

NPI assigned

Oct 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

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

Family PracticeAlso: Psychiatry

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Cedar Ridge Behavioral Health Solutions LLCGroup PAC ID 5698927432, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Otterbein Universal Home Health & Hospice Home health agency, Bellefontaine, OH, CCN 367404
• Mary Rutan Hospital Hospital, Bellefontaine, OH, CCN 360197
• Memorial Hospital Hospital, Marysville, OH, CCN 360092
• Wilson Memorial Hospital Hospital, Sidney, OH, CCN 360013

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Cedar Ridge Behavioral Health Solutions LLC

  • Community/Behavioral Health Agency
  • Cambridge, OH
  • NPI 1063779460
  Medicare reassignment Care Compare group NPD
• Logan Family Medical Center LLC

  • Primary Care Clinic/Center
  • Bellefontaine, OH
  • NPI 1285824979
  Medicare reassignment NPD Authorized official
• Cedar Ridge Behavioral Health Solutions

  • Community/Behavioral Health Agency
  • Cambridge, OH
  • NPI 1447769666
  NPD (past)
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)
• Mary Rutan Hospital

  • Family Medicine Physician
  • West Liberty, OH
  • NPI 1003875949
  NPD (past)
• Mary Rutan Hospital

  • Surgery Physician
  • Bellefontaine, OH
  • NPI 1689712879
  NPD (past)

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

• Care at Home by Green Hills LLC

  • Home Health Agency
  • Bellefontaine, OH
  • NPI 1538222021
  Care Compare affiliation
• Mary Rutan Hospital

  • General Acute Care Hospital
  • Bellefontaine, OH
  • NPI 1548254931
  Care Compare affiliation
• Memorial Hospital of Union County

  • General Acute Care Hospital
  • Marysville, OH
  • NPI 1720159338
  Care Compare affiliation
• Shelby County Memorial Hospital Association Inc.

  • General Acute Care Hospital
  • Sidney, OH
  • NPI 1639174204
  Care Compare affiliation

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083795850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2210 TIMBER TRAIL",
            "city": "BELLEFONTAINE",
            "state": "OH",
            "postal_code": "43311",
            "telephone_number": "937-593-3151",
            "fax_number": "937-593-5438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "LOGAN FAMILY MEDICAL CENTER LLC",
            "address_2": "2210 TIMBER TRAIL",
            "city": "BELLEFONTAINE",
            "state": "OH",
            "postal_code": "43311",
            "telephone_number": "937-593-3151",
            "fax_number": "937-593-5438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIVAPRASAD",
        "first_name": "MABBU",
        "middle_name": "GAJAPATHY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35-072257",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2017373",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Ann Scriven, M.D.
• Julie A Seaford
• Catherine L Seibert, APRN, CFNP
• Beverly Lynn Shelton
• Sarah Louise Shirk, HAS
• Lara Shoemaker, MSW, LISW-S
• Taylor Short
• Richard Shramo, D.P.M
• Craig O Siegel, MD
• Jennifer Noel Skidmore, MSPT

• Family Medicine Physician in Bellefontaine, OH
• Providers in Bellefontaine, OH by specialty
• Family Medicine Physician in Ohio

• 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.
• 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.