Suresh Sreedharan, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

47461 Issued in MN

Practice address

219 Brooks Avenue North
Thief River Falls, MN 56701

Phone

(218) 681-4673

NPI assigned

Jul 6, 2006

Last updated

Mar 6, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hope Pediatrics PLLC

  • Clinic/Center
  • Thief River Falls, MN
  • NPI 1467856658
  Medicare reassignment NPD Authorized official
• Hearing on Main Corporation

  • Audiologist-Hearing Aid Fitter
  • Thief River Falls, MN
  • NPI 1003277203
  NPD

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425600000000",
    "number": "1285665067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 BROOKS AVENUE NORTH",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "56701",
            "telephone_number": "218-681-4673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 BROOKS AVENUE NORTH",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "56701",
            "telephone_number": "218-681-4673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SREEDHARAN",
        "first_name": "SURESH",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2015-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "47461",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "61310-20",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285665067",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Ann Slaathaug Hawley
• Kyle Laurence Slaathaug, FNP-BC
• Ronald Maurice Smith, M.D.
• Miranda Elizabeth Solem, LADC
• Soheil Souri
• Terry Lee Storm, R.PH.
• Eiley Christina Sundby, M.S., CCC-SLP
• Chad Henry Tabatt, PT
• Irene V Tevlin, PMHNP-BC
• Thief River Falls Family Dentistry

• Pediatrics Physician in Thief River Falls, MN
• Providers in Thief River Falls, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.