Individual provider Active NPI

Preeti Venkataraman, M.D.

  • Pediatrics Physician
  • Novi, MI
National Provider Identifier
1215093778
Registry record updated Jun 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
D76987 Issued in MD
Practice address
50002 Streamwood Dr
Novi, MI 48374-2148
Phone
(646) 271-6140
NPI assigned
Dec 29, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X D76987 MD Primary
Hospitalist Physician 208M00000X D76987 MD
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 240869 NY

Addresses

Primary practice location

50002 Streamwood Dr
Novi, MI 48374-2148

Mailing address

50002 Streamwood Dr
Novi, MI 48374-2148
Phone (646) 271-6140

Other identifiers 1

IdentifierTypeStateIssuer
02808551MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20180712002689 MD Practitioner - Pediatric MedicinePractitioner - Hospitalist 8820270234 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
240869NYMDPediatric Emergency Medicine (Pediatrics) Physician
D76987MDMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Maryland Community Medical Group, Inc. Pediatrics CurrentSince Jul 1, 2018 Accepting new patients
University of Maryland Community Medical Group, Inc. CurrentSince Jul 1, 2018 Accepting new patients

Locations

2540 Centreville Rd
Centreville, MD 21617
Phone (410) 758-4432

301 Hospital Dr
Glen Burnie, MD 21061
Phone (410) 787-4565

Organizations & group practices 2

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": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529884800000",
    "number": "1215093778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50002 STREAMWOOD DR",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483742148",
            "telephone_number": "646-271-6140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50002 STREAMWOOD DR",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483742148",
            "telephone_number": "646-271-6140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENKATARAMAN",
        "first_name": "PREETI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-29",
        "last_updated": "2018-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D76987",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MD",
            "license": "D76987",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "NY",
            "license": "240869",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02808551",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Novi, MI

Sources for this page

Verify at the official NPI Registry.