Individual provider Active NPI

Balaji Raghu-Obleshwar, MD

  • Internal Medicine Physician
  • St Petersburg, FL
National Provider Identifier
1104812999
Registry record updated Mar 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME110870 Issued in FL
Practice address
10051 5TH St N Ste 200
St Petersburg, FL 33702-2211
Phone
(727) 824-0780
Fax
(813) 514-8891
NPI assigned
Sep 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME110870 FL Primary

Addresses

Primary practice location

10051 5TH St N Ste 200
St Petersburg, FL 33702-2211

Mailing address

10051 5TH St N Ste 200
St Petersburg, FL 33702-2211
Phone (727) 824-0780

Other identifiers 2

IdentifierTypeStateIssuer
015454700MedicaidFL
IH298YOtherFLMEDICARE PIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20150926000052 FL Practitioner - Internal Medicine 0446305346 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optumcare Florida, LLCGroup PAC ID 3072403476, 266 clinicians

Practice addresses (Care Compare)

1345 W Bay Dr
202 Optum Largo
Largo, FL 33770-2276
Phone (727) 559-0895

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME110870FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optumcare Florida LLC Internal Medicine Current Accepting new patients
Optumcare Florida, LLC CurrentSince Jun 11, 2018 Accepting new patients
Fredericksburg Hospitalist Group, P.C. Internal Medicine Past Accepting new patients
Optumcare Florida Ci, LLC Past Accepting new patients

Locations

1345 West Bay Dr
Ste 202
Largo, FL 33770
Phone (727) 559-0895

10051 5th St N
Ste 200
St Petersburg, FL 33702
Phone (727) 286-4093

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: balajiraghu@brmd.allscriptsdirect.net

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1127779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583798400000",
    "number": "1104812999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10051 5TH ST N STE 200",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337022211",
            "telephone_number": "727-824-0780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10051 5TH ST N STE 200",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337022211",
            "telephone_number": "727-824-0780",
            "fax_number": "813-514-8891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAGHU-OBLESHWAR",
        "first_name": "BALAJI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-27",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME110870",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "015454700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "IH298Y",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.