NPIMap

Individual provider Active NPI

Sivaram Kollengode, M.D.

  • Family Medicine Physician
  • Cambridge, OH
National Provider Identifier
1154373561
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35.066988 Issued in OH
Practice address
1210 Clark St
Cambridge, OH 43725-9611
Phone
(740) 435-2468
Fax
(740) 439-7251
NPI assigned
May 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35.066988 OH Primary

Addresses

Primary practice location

1210 Clark St
Cambridge, OH 43725-9611

Mailing address

1251 Clark St
Cambridge, OH 43725-9612
Phone (740) 439-0733

Other identifiers 1

IdentifierTypeStateIssuer
0119848MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address SRKollengode@seormc.org Direct Southeastern Ohio Regional Medical Center Inc

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson Flanigan MD LLC Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
4M Emergency Systems Andover LLC Past Accepting new patients
Osu Internal Medicine, LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: srkollengode@seormc.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1154373561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1251 CLARK ST",
            "city": "CAMBRIDGE",
            "state": "OH",
            "postal_code": "437259612",
            "telephone_number": "740-439-0733",
            "fax_number": "740-439-8996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 CLARK ST",
            "city": "CAMBRIDGE",
            "state": "OH",
            "postal_code": "437259611",
            "telephone_number": "740-435-2468",
            "fax_number": "740-439-7251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLENGODE",
        "first_name": "SIVARAM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2023-11-27",
        "certification_date": "2020-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.066988",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0119848",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "SRKollengode@seormc.org",
            "affiliation": "Y",
            "affiliationName": "Southeastern Ohio Regional Medical Center Inc",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1210 Clark St",
            "city": "Cambridge",
            "state": "OH",
            "country_code": "US",
            "postal_code": "437259611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cambridge, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.