Revati Mummaneni, M.D.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

50905 Issued in AZ

Practice address

4400 N Scottsdale Rd
Ste 9841
Scottsdale, AZ 85251-3331

Phone

(248) 390-4503

NPI assigned

Jun 29, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Revati Mummaneni Other name

Medicare fee-for-service enrollment

Enrolled in AZ

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

State licenses

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

{
    "created_epoch": "1277769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460592000000",
    "number": "1285945758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 N SCOTTSDALE RD",
            "address_2": "STE 9841",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852513331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 N SCOTTSDALE RD",
            "address_2": "STE 9841",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852513331",
            "telephone_number": "248-390-4503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUMMANENI",
        "first_name": "REVATI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-29",
        "last_updated": "2016-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "R71974",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "AZ",
            "license": "50905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAINING PERMIT",
            "identifier": "R71974",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REVATI",
            "last_name": "MUMMANENI",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Multi Specialty Physicians Group Inc
• Multispecialty Group of Arizona LLC
• Diana R Mulumba-Lubandi, CRNA
• Kelli Mulvaney
• Anita Diwakar Mulye, M.D.
• Eileen Munch, PHARM.D.
• Miranda Munch, BHT
• Elizabeth Dvorak Munger, RN
• Medi Gatmaitan Munin, RNFA
• Joshua Munoz

• Physical Medicine & Rehabilitation Physician in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Physical Medicine & Rehabilitation Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2016; 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.