Individual provider Active NPI

Aditya Neravetla, MD

  • Internal Medicine Physician
  • Brockton, MA
National Provider Identifier
1346478088
Registry record updated Apr 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
252341 Issued in MA
Practice address
63 Main St
Brockton, MA 02301-4042
Phone
(508) 559-6699
Fax
(508) 559-5073
NPI assigned
Jul 1, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 5, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301093949 MI
Internal Medicine Physician 207R00000X 252341 MA Primary

Addresses

Primary practice location

63 Main St
Brockton, MA 02301-4042

Mailing address

63 Main St
Brockton, MA 02301-4042
Phone (508) 559-6699

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161004001720 MI Practitioner - HospitalistPractitioner - Internal Medicine 7517118912 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sound Inpatient Physicians - Michigan, PLLC Internal Medicine CurrentSince Aug 10, 2016 Accepting new patients
Hospitalist Medicine Physicians of Michigan PLLC Internal Medicine CurrentSince Jan 1, 2022 Accepting new patients
Hospitalist Medicine Physicians of Michigan, PLLC Internal Medicine Current Accepting new patients
Sound Inpatient Physicians-Michigan PLLC Internal Medicine CurrentSince Aug 10, 2016 Accepting new patients
Sound Inpatient Physicians-Michigan, PLLC Internal Medicine Current Accepting new patients
Steward Medical Group, Inc Past Accepting new patients
Munson Healthcare Grayling PastSince Apr 30, 2021 Accepting new patients
Brockton Neighborhood Health Center, Inc. PastSince Apr 6, 2023 Accepting new patients

Locations

1501 W Chisholm St
Alpena, MI 49707
Phone (989) 356-7000

1 Genesys Pkwy
Grand Blanc, MI 48439
Phone (810) 606-5733

1100 E Michigan Ave
Grayling, MI 49738
Phone (989) 348-0317

1 Atkinson Dr
Ludington, MI 49431
Phone (231) 843-2591

580 W College Ave
Marquette, MI 49855
Phone (906) 225-3131

1221 Pine Grove Ave
Port Huron, MI 48060
Phone (810) 989-3300

800 S Washington Ave
Saginaw, MI 48601
Phone (989) 776-8000

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

5410 Maryland Way
Ste 300
Brentwood, TN 37027
Phone (615) 377-1674

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1246406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459814400000",
    "number": "1346478088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 MAIN ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023014042",
            "telephone_number": "508-559-6699",
            "fax_number": "508-559-5073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 MAIN ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023014042",
            "telephone_number": "508-559-6699",
            "fax_number": "508-559-5073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NERAVETLA",
        "first_name": "ADITYA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-01",
        "last_updated": "2016-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301093949",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "252341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

Verify at the official NPI Registry.