Individual provider Active NPI

Supawat Ratanapo, M.D.

  • Interventional Cardiology Physician
  • Lynchburg, VA
National Provider Identifier
1255627923
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
0101281156 Issued in VA
Practice address
2410 Atherholt Rd
Lynchburg, VA 24501-2148
Phone
(434) 200-5252
Fax
(434) 200-2851
NPI assigned
Jun 21, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 0101281156 VA
Interventional Cardiology Physician 207RI0011X 0101281156 VA Primary

Addresses

Primary practice location

2410 Atherholt Rd
Lynchburg, VA 24501-2148

Mailing address

2410 Atherholt Rd
Lynchburg, VA 24501-2148
Phone (434) 200-5252

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240813002382 VA Practitioner - Interventional Cardiology 0446541726 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional Cardiology
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centra Medical Group LLCGroup PAC ID 4789606088, 709 clinicians

Practice addresses (Care Compare)

104 Carolina Ave
Brookneal, VA 24528-2643
Phone (434) 376-2325

115 Ambriar PLZ
Amherst, VA 24521-4741
Phone (434) 946-9565

125 Nationwide Dr
Lynchburg, VA 24502-4272
Phone (434) 200-3908

1280 Main St a
Altavista, VA 24517-1465
Phone (434) 309-1165

1613 Oakwood St
Bedford, VA 24523-1213

16890 Forest Rd
Forest, VA 24551-4059
Phone (434) 200-7210

1901 Tate Springs Rd
Lynchburg, VA 24501-1109
Phone (434) 947-3033

2410 Atherholt Rd
Lynchburg, VA 24501-2148
Phone (434) 200-1800

291 McBride LN
Gretna, VA 24557-2773
Phone (434) 656-1274

3300 Rivermont Ave
Lynchburg, VA 24503-2030
Phone (434) 200-5999

4830 Rucker Rd
Moneta, VA 24121-5281
Phone (540) 297-7181

800 Oak St
Farmville, VA 23901-1199
Phone (434) 315-2998

900 W 3Rd St
Farmville, VA 23901-1131
Phone (434) 392-4370

915 S Main St
Farmville, VA 23901-2211
Phone (434) 414-3978

935 S Main St
Farmville, VA 23901-2211
Phone (434) 315-5340

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.16 of 100Reported as apm
Quality
83.58
Promoting interoperability
94
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting36
Pacemaker insertion or repair1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Centra Medical Group, LLC CurrentSince Jul 22, 2024 Accepting new patients

Locations

140 Vista Centre Dr
Fl 2
Forest, VA 24551
Phone (434) 200-2297

2410 Atherholt Rd
Lynchburg, VA 24501
Phone (434) 200-5252

1901 Tate Springs Rd
Lynchburg, VA 24501
Phone (434) 200-3101

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 9

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": "1308614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1255627923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2410 ATHERHOLT RD",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245012148",
            "telephone_number": "434-200-5252",
            "fax_number": "434-200-2851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2410 ATHERHOLT RD",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245012148",
            "telephone_number": "434-200-5252",
            "fax_number": "434-200-2851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RATANAPO",
        "first_name": "SUPAWAT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-21",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "VA",
            "license": "0101281156",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "VA",
            "license": "0101281156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynchburg, VA

Sources for this page

Verify at the official NPI Registry.