Individual provider Active NPI

Nandakumar Srinivasan, MD

  • Gastroenterology Physician
  • Seattle, WA
National Provider Identifier
1235270927
Registry record updated Jul 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD60349184 Issued in WA
Practice address
1100 9TH Ave
Ms:C3-Gas
Seattle, WA 98101-2756
Phone
(206) 223-2319
Fax
(206) 341-1188
NPI assigned
Feb 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2013

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 104821 MN
Internal Medicine Physician 207R00000X 24986 OK
Gastroenterology Physician 207RG0100X 53201 MN
Gastroenterology Physician 207RG0100X MD60349184 WA Primary

Addresses

Primary practice location

1100 9TH Ave
Ms:C3-Gas
Seattle, WA 98101-2756

Mailing address

1100 9TH Ave
Seattle, WA 98101-2756
Phone (206) 515-5811

Other identifiers 3

IdentifierTypeStateIssuer
1235270927MedicaidWA
P00849771OtherMNMEDICARE, RAILROAD
ENROLLEDMedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20140916001687 OR Practitioner - GastroenterologyPractitioner - Internal Medicine 6103950530 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Peacehealth Medical GroupGroup PAC ID 9032023270, 256 clinicians

Practice addresses (Care Compare)

3333 Riverbend Dr
Springfield, OR 97477-8800
Phone (541) 222-6000

3355 Riverbend Dr
Suite 400
Springfield, OR 97477-8800
Phone (541) 222-2402

3377 Riverbend Dr
Springfield, OR 97477-8800
Phone (541) 222-6000

4010 Aerial Way
Eugene, OR 97402-9757
Phone (613) 272-4978

Hospital & facility affiliations

  • Sacred Heart Medical Center - Riverbend Hospital, Springfield, OR, CCN 380102
  • Peace Harbor Medical Center Hospital, Florence, OR, CCN 381316

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy124
Upper gastrointestinal (GI) endoscopy for acid reflux166

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
24986OKMDInternal Medicine Physician
MD60349184WAMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Peacehealth Medical Group Internal Medicine CurrentSince Aug 25, 2014 Accepting new patients

Locations

4010 Aerial Way
Eugene, OR 97402
Phone (541) 242-8300

1115 SE 164th Ave
Dept 358
Vancouver, WA 98683
Phone (360) 729-1253

Interoperability endpoints

  • Direct secure messaging: nsrinivasan62877@direct.peacehealth.org

Organizations & group practices 1

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373932800000",
    "number": "1235270927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 9TH AVE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981012756",
            "telephone_number": "206-515-5811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 9TH AVE",
            "address_2": "MS:C3-GAS",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981012756",
            "telephone_number": "206-223-2319",
            "fax_number": "206-341-1188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SRINIVASAN",
        "first_name": "NANDAKUMAR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-08",
        "last_updated": "2013-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MN",
            "license": "104821",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "24986",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MN",
            "license": "53201",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "WA",
            "license": "MD60349184",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235270927",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE, RAILROAD",
            "identifier": "P00849771",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.