Individual provider Active NPI

Ravy K. Vajravelu, MD

  • Gastroenterology Physician
  • Philadelphia, PA
National Provider Identifier
1205196599
Registry record updated Sep 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD457602 Issued in PA
Practice address
3400 Civic Center Blvd FL 4
Philadelphia, PA 19104-5127
Phone
(215) 349-8222
Fax
(215) 662-6530
NPI assigned
May 21, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X MD457602 PA Primary
Internal Medicine Physician 207R00000X MD457602 PA

Addresses

Primary practice location

3400 Civic Center Blvd FL 4
Philadelphia, PA 19104-5127

Mailing address

3400 Civic Center Blvd FL 4
Philadelphia, PA 19104-5127
Phone (215) 349-8222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20180821003874 PA Practitioner - Gastroenterology 8426354440 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group CurrentSince Jul 1, 2018 Accepting new patients
University of Penn - Medical Group Gastroenterology CurrentSince Jul 1, 2018 Accepting new patients
University of Pittsburgh Physicians CurrentSince Mar 3, 2022 Accepting new patients
University of Pittsburgh Physicians Gastroenterology CurrentSince Mar 3, 2022 Accepting new patients

Locations

3400 Civic Center Blvd
Fl 4
Philadelphia, PA 19104
Phone (215) 662-3580

230 W Washington Sq
Fl 4
Philadelphia, PA 19106
Phone (215) 829-3561

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

300 Halket St
Pittsburgh, PA 15213
Phone (412) 641-1000

2 Hot Metal St
#One
Pittsburgh, PA 15203
Phone (412) 432-5864

250 King of Prussia Rd
Ste 1B
Radnor, PA 19087
Phone (610) 902-1500

Interoperability endpoints

  • Direct secure messaging: ravy.k.vajravelu@upmcdirect.com

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": "1337558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569456000000",
    "number": "1205196599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD FL 4",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045127",
            "telephone_number": "215-349-8222",
            "fax_number": "215-662-6530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD FL 4",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045127",
            "telephone_number": "215-349-8222",
            "fax_number": "215-662-6530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAJRAVELU",
        "first_name": "RAVY",
        "middle_name": "K.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-21",
        "last_updated": "2019-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "PA",
            "license": "MD457602",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD457602",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.