Individual provider Active NPI

Srivadee Oravivattanakul, MD

  • Neurology Physician
  • Allen, TX
National Provider Identifier
1306097084
Registry record updated Jan 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
T1170 Issued in TX
Practice address
907 Panther LN
Allen, TX 75013-4879
Phone
(612) 423-6261
NPI assigned
Oct 1, 2008
Last updated
Jan 10, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 10, 2022

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 01086134A IN
Neurology Physician 2084N0400X ME143886 FL
Neurology Physician 2084N0400X 25MA11151800 NJ
Neurology Physician 2084N0400X 75834-20 WI
Neurology Physician 2084N0400X T1170 TX Primary

Addresses

Primary practice location

907 Panther LN
Allen, TX 75013-4879

Mailing address

907 Panther LN
Allen, TX 75013-4879
Phone (612) 423-6261

Other practice location 1

1701 S Creasy Ln
Lafayette, IN 47905-4972
Phone (765) 502-4400

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address soravivattanakul601017@Direct.FranciscanAlliance.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, WI, VA, TX4 enrollments
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 4

Enrollment IDStateProvider typePAC IDDetails
I20220311001346 NJ Practitioner - Neurology 4385862333 Reassigns benefits to 2 organizations
I20220408001277 WI Practitioner - Neurology 4385862333 Reassigns benefits to 1 organization
I20230326000153 VA Practitioner - Neurology 4385862333 Reassigns benefits to 1 organization
I20231018003380 TX Practitioner - Neurology 4385862333

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2000 Health Park Dr
Brentwood, TN 37027-4692

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME143886FLMDNeurology Physician
75834-20WIMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Atlanticare Physician Group, PA CurrentSince Dec 9, 2021 Accepting new patients
Bellin Memorial Hospital Inc Family Medicine CurrentSince Dec 30, 2021 Accepting new patients
Atlanticare Physician Group PA Family Medicine CurrentSince Dec 9, 2021 Accepting new patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Nov 9, 2024 Accepting new patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Nov 9, 2024 Accepting new patients
Bon Secours Medical Group Richmond Specialty Care LLC Neurology CurrentSince Dec 1, 2022 Accepting new patients
The Austin Diagnostic Clinic, PLLC Current Accepting new patients
Bellin Memorial Hospital Inc Family Medicine Current Accepting new patients
The Austin Diagnostic Clinic, PLLC CurrentSince Oct 1, 2023 Accepting new patients
Bon Secours Medical Group Richmond Specialty Care LLC CurrentSince Dec 1, 2022 Accepting new patients
Neurology Associates of Ormond Beach Neurology Current Accepting new patients
Austin Diagnostic Clinic CurrentSince Oct 1, 2023 Accepting new patients
Bellin Memorial Hospital Inc Family Medicine CurrentSince Dec 30, 2021 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients
The Austin Diagnostic Clinic, PLLC Past Accepting new patients
Austin Diagnostic Clinic, PA Past Accepting new patients
Ozarks Medical Center Family Medicine Past Accepting new patients

Locations

8 Mirror Lake Dr
Ste A
Ormond Beach, FL 32174
Phone (386) 673-2500

1925 Pacific Ave
Atlantic City, NJ 08401
Phone (609) 441-8023

733 N Beers St
Holmdel, NJ 07733
Phone (732) 264-8484

459 Route 9 S
Little Egg Harbor Twp, NJ 08087
Phone (609) 340-7815

1944 State Route 33
Neptune, NJ 07753
Phone (732) 776-3787

3600 State Route 66
Fl 3
Neptune City, NJ 07753
Phone (732) 807-0463

530 New Brunswick Ave
Perth Amboy, NJ 08861
Phone (732) 324-5007

1 Riverview Plz
Red Bank, NJ 07701
Phone (732) 530-2204

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

12221 N Mopac Expy
Austin, TX 78758
Phone (512) 901-2530

1510 N 28th St
Ste 110
Richmond, VA 23223
Phone (804) 545-2304

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DGHCCA
  • FHIR API: https://fhir4.healow.com/fhir/r4/IHJHBD
  • Direct secure messaging: soravivattanakul601017@direct.franciscanalliance.org
  • Direct secure messaging: srivadee.oravivattanakul.1@8478.direct.athenahealth.com
  • Direct secure messaging: srivadee.oravivattanakul@hca8.eclinicaldirectplus.com

Organizations & group practices 17

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.

View all 17

Hospital & facility affiliations 1

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": "1222819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1306097084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 PANTHER LN",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750134879",
            "telephone_number": "612-423-6261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 PANTHER LN",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750134879",
            "telephone_number": "612-423-6261"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1701 S Creasy Ln",
            "address_purpose": "LOCATION",
            "city": "Lafayette",
            "state": "IN",
            "postal_code": "479054972",
            "country_code": "US",
            "telephone_number": "765-502-4400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ORAVIVATTANAKUL",
        "first_name": "SRIVADEE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-01",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IN",
            "license": "01086134A",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME143886",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NJ",
            "license": "25MA11151800",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WI",
            "license": "75834-20",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "TX",
            "license": "T1170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "soravivattanakul601017@Direct.FranciscanAlliance.org",
            "affiliation": "N",
            "address_1": "1701 S Creasy Ln",
            "city": "Lafayette",
            "state": "IN",
            "country_code": "US",
            "postal_code": "479054972",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Allen, TX

Sources for this page

Verify at the official NPI Registry.