Active NPI
Kavitha Srinivasan, MD
- Family Medicine Physician
- Cheyenne, WY
National Provider Identifier
1124712856
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 228-T2
- Practice address
- 820 E 17TH St
Cheyenne, WY 82001-4714 - Phone
- (307) 632-2434
- Fax
- (307) 634-3510
- NPI assigned
- Jun 6, 2023
- Last updated
- Sep 24, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | W7138 | TX | |
| Family Medicine Physician | 207Q00000X | 228-T2 | WY | Primary |
Addresses
Primary practice location
820 E 17TH St
Cheyenne, WY 82001-4714
Mailing address
11511 Shadow Creek Pkwy
Credentialing Services
Pearland, TX 77584-7298
Phone (713) 442-0000
Other practice location 1
25553 Highway 59
Porter, TX 77365-6154
Phone (713) 442-2100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240801003594 | WY | Order and Referring Only - Family Practice | 5294272712 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 228-T2 | WY | MD | Family Medicine Physician |
Interoperability endpoints
- kavitha.srinivasan.1@30244.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1790208000000",
"number": "1124712856",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11511 SHADOW CREEK PKWY",
"address_2": "CREDENTIALING SERVICES",
"city": "PEARLAND",
"state": "TX",
"postal_code": "775847298",
"telephone_number": "713-442-0000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "820 E 17TH ST",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820014714",
"telephone_number": "307-632-2434",
"fax_number": "307-634-3510"
}
],
"practiceLocations": [
{
"address_1": "25553 Highway 59",
"address_purpose": "LOCATION",
"city": "Porter",
"state": "TX",
"postal_code": "773656154",
"country_code": "US",
"telephone_number": "713-442-2100",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SRINIVASAN",
"first_name": "KAVITHA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-06",
"last_updated": "2026-09-24",
"certification_date": "2026-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "W7138",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WY",
"license": "228-T2",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cheyenne, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2026; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.