NPIMap

Organization Active NPI

Srisai Gowda MD LLC

  • Psychiatry Physician
  • Linwood, NJ
National Provider Identifier
1245361583
Registry record updated Dec 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
25MA06553300 Issued in NJ
Legal business name
SRISAI GOWDA MD LLC
Practice address
2106 New Road
D-8
Linwood, NJ 08221
Phone
(609) 927-1030
Fax
(609) 927-9985
NPI assigned
Mar 8, 2007
Last updated
Dec 13, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2019

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

Authorized official

Name
Dr. Srisai Gowda, M.D.NPI 1801995352
Title
Owner
Phone
(609) 927-1030

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 25MA06553300 NJ Primary

Addresses

Primary practice location

2106 New Road
D-8
Linwood, NJ 08221

Mailing address

2106 New Road
D-8
Linwood, NJ 08221
Phone (609) 927-1030

Other names 1

  • SHORE PSYCHIATRIC EVLUATION AND COUNSELING Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040803000024 NJ Part B Supplier - Clinic/Group Practice 2466423678 Receives reassigned benefits from 8 practitioners
Practice locations: Linwood, NJ

National Provider Directory

National Provider Directory

Locations

2106 New Rd
Ste D8
Linwood, NJ 08221
Phone (609) 927-1030

2106 New Rd
Ste D8
Linwood, NJ 08221
Phone (609) 344-1118

408 Bethel Rd
Ste D-201
Somers Point, NJ 08244

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576195200000",
    "number": "1245361583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2106 NEW ROAD",
            "address_2": "D-8",
            "city": "LINWOOD",
            "state": "NJ",
            "postal_code": "08221",
            "telephone_number": "609-927-1030",
            "fax_number": "609-927-9985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2106 NEW ROAD",
            "address_2": "D-8",
            "city": "LINWOOD",
            "state": "NJ",
            "postal_code": "08221",
            "telephone_number": "609-927-1030",
            "fax_number": "609-927-9985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRISAI GOWDA MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2019-12-13",
        "certification_date": "2019-12-13",
        "status": "A",
        "authorized_official_last_name": "GOWDA",
        "authorized_official_first_name": "SRISAI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "609-927-1030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "25MA06553300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHORE PSYCHIATRIC EVLUATION AND COUNSELING",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "SHORE PSYCHIATRIC EVLUATION AND COUNSELING",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Linwood, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.