Srinivas Ketharaju, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

280458 Issued in NY

Practice address

3 Lyon PL
Ogdensburg, NY 13669-2590

Phone

(315) 713-6700

Fax

(866) 816-0815

NPI assigned

May 7, 2008

Sex

Male

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

Medicare fee-for-service enrollment

Enrolled in NY, MA2 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 2

Specialty

Obstetrics/Gynecology

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mary Imogene Bassett HospitalGroup PAC ID 3779488325, 780 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bassett Healthcare Hospital, Cooperstown, NY, CCN 330136
• Aurelia Osborn Fox Memorial Hospital Hospital, Oneonta, NY, CCN 330085

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sketharaju342121@bassett.direct-ci.net

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.

• Mary Imogene Bassett Hospital

  • Multi-Specialty Clinic/Center
  • Cooperstown, NY
  • NPI 1083664221
  Medicare reassignment Care Compare group NPD
• Mary Imogene Bassett Hospital

  • Specialty Pharmacy
  • Oneonta, NY
  • NPI 1174419196
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Aurelia Osborn Fox Memorial Hospital Society

  • General Acute Care Hospital
  • Oneonta, NY
  • NPI 1578529954
  Care Compare affiliation
• Mary Imogene Bassett Hospital

  • Rural Acute Care Hospital
  • Cooperstown, NY
  • NPI 1780600577
  Care Compare affiliation

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

{
    "created_epoch": "1210118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724889600000",
    "number": "1346416559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 MOUNT AUBURN ST # 2",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021385597",
            "telephone_number": "781-893-5550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 LYON PL",
            "city": "OGDENSBURG",
            "state": "NY",
            "postal_code": "136692590",
            "telephone_number": "315-713-6700",
            "fax_number": "866-816-0815"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "355 Waverly Oaks Rd Ste 275",
            "address_purpose": "LOCATION",
            "city": "Waltham",
            "state": "MA",
            "postal_code": "024528477",
            "country_code": "US",
            "telephone_number": "781-893-5550",
            "fax_number": "781-893-4965",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KETHARAJU",
        "first_name": "SRINIVAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-07",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "KY",
            "license": "43564",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MA",
            "license": "1016377",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "280458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04262126",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anitra E Kellar, REGISTERED PROFESSIO
• Kelly Lynn Scott, MD
• Nicole Marie Kennedy, PH-MHC
• Syeannah M Kennedy
• Melissa Kenney, PSYD
• Keystone America
• Trudy M Kiah, RPAC
• Kimro Inc
• Matthew Aldridge King, CRT
• Jacob H Kinney, PEER SUPPORT

• Obstetrics & Gynecology Physician in Ogdensburg, NY
• Providers in Ogdensburg, NY by specialty
• Obstetrics & Gynecology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.