Individual provider Active NPI

Ravinder S. Gill

  • Family Medicine Physician
  • Grandview, MO
National Provider Identifier
1376148478
Registry record updated Dec 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2020017669 Issued in MO
Practice address
13013 Fuller Ave Ste a
Grandview, MO 64030-2687
Phone
(816) 214-5548
NPI assigned
Dec 4, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2020017669 MO Primary

Addresses

Primary practice location

13013 Fuller Ave Ste a
Grandview, MO 64030-2687

Mailing address

404 Chinquapin Orch
Yorktown, VA 23693-2327
Phone (757) 291-7039

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2020017669MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Medina Clinic, Incorporated PastSince Dec 6, 2020 Accepting new patients

Organizations & group practices 1

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": "1607040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1376148478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 CHINQUAPIN ORCH",
            "city": "YORKTOWN",
            "state": "VA",
            "postal_code": "236932327",
            "telephone_number": "757-291-7039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13013 FULLER AVE STE A",
            "city": "GRANDVIEW",
            "state": "MO",
            "postal_code": "640302687",
            "telephone_number": "816-214-5548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILL",
        "first_name": "RAVINDER",
        "middle_name": "S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-04",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2020017669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grandview, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.