Vidyashankar B Revan, M.D

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

35080833 Issued in OH

Practice address

110 Fairway Dr
Suite # 2
Wilmington, OH 45177-8756

Phone

(937) 655-9179

Fax

(937) 655-9139

NPI assigned

Jan 3, 2007

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

Other names 1

• Vidyashankar B Revannasiddappa Former name

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

Allergy/Immunology

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PSF PLLCGroup PAC ID 1557265543, 98 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

84.25 of 100Reported as group

Quality

86.03

Promoting interoperability

86

Improvement activities

40

Cost

73.15

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: vidyashankar.revan.familyallergyasthma@faa.meditab.direct-ci.com

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.

• PSF PLLC

  • Allergy & Immunology Physician
  • Louisville, KY
  • NPI 1881785947

  OH

  Medicare reassignment Care Compare group NPD
• Allergy and Asthma Associates LLC

  • Allergy & Immunology Physician
  • Kettering, OH
  • NPI 1649474883
  NPD (past)

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1194882571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9800 SHELBYVILLE RD STE 220",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402232992",
            "telephone_number": "502-429-8585",
            "fax_number": "502-753-0889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 FAIRWAY DR",
            "address_2": "SUITE # 2",
            "city": "WILMINGTON",
            "state": "OH",
            "postal_code": "451778756",
            "telephone_number": "937-655-9179",
            "fax_number": "937-655-9139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVAN",
        "first_name": "VIDYASHANKAR",
        "middle_name": "B",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-03",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "OH",
            "license": "35080833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2321660",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VIDYASHANKAR",
            "last_name": "REVANNASIDDAPPA",
            "middle_name": "B",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michelle Reinsmith, AT
• Mary Theresa Rembert, LPCC
• Renal Life Link Inc
• Richard Renner, R.PH.
• Tracy Resibois-Binkley, CNP
• Alex Rhinehart
• Jason L Rich, M.D.
• Cynthia Richey, CMA
• Zachary E Richmond, CT, LCDC III
• Rick D Compton MD

• Allergy & Immunology Physician in Wilmington, OH
• Providers in Wilmington, OH by specialty
• Allergy & Immunology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; 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.