Individual provider Active NPI

Sally Ravanos, M.D.

  • Internal Medicine Physician
  • Raleigh, NC
National Provider Identifier
1083835078
Registry record updated Mar 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2009-00012 Issued in NC
Practice address
4420 Lake Boone TRL
Raleigh, NC 27607-7505
Phone
(919) 784-7093
Fax
(919) 784-7395
NPI assigned
May 1, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 24, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2009-00012 NC
Internal Medicine Physician 207R00000X 2009-00012 NC Primary

Addresses

Primary practice location

4420 Lake Boone TRL
Raleigh, NC 27607-7505

Mailing address

4420 Lake Boone TRL
Raleigh, NC 27607-7505
Phone (919) 784-7093

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sravanos78328@direct.UNC.nchie.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20090617000561 NC Practitioner - Internal MedicinePractitioner - Pediatric MedicinePractitioner - Hospitalist 0648320341 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
University of Alabama School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Carolina MG LLCGroup PAC ID 1951828847, 723 clinicians

Practice addresses (Care Compare)

4420 Lake Boone TRL
Suite 200
Raleigh, NC 27607-7505
Phone (919) 784-1410

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2009-00012NCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Carolina MG, LLC CurrentSince Jun 1, 2025 Accepting new patients
Rex Hospital Inc Past Accepting new patients
Rex Hospital, Inc. Past Accepting new patients

Locations

850 S Main St
Holly Springs, NC 27540
Phone (919) 784-7093

4420 Lake Boone Trl
Raleigh, NC 27607
Phone (919) 784-3034

4420 Lake Boone Trl
Ste 200
Raleigh, NC 27607
Phone (919) 784-1097

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1083835078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4420 LAKE BOONE TRL",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077505",
            "telephone_number": "919-784-7093",
            "fax_number": "919-784-7395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4420 LAKE BOONE TRL",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077505",
            "telephone_number": "919-784-7093",
            "fax_number": "919-784-7395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAVANOS",
        "first_name": "SALLY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-01",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2009-00012",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2009-00012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sravanos78328@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "4420 Lake Boone Trl",
            "city": "Raleigh",
            "state": "NC",
            "country_code": "US",
            "postal_code": "276077505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.