Individual provider Active NPI

Ravinder R Polasani, MD

  • Allergy Physician
  • Jackson, MI
National Provider Identifier
1376517359
Registry record updated Jan 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy PhysicianTaxonomy code 207KA0200X
License
RP073528 Issued in MI
Practice address
833 Laurence Ave
Jackson, MI 49202-2981
Phone
(517) 782-1700
Fax
(517) 787-9512
NPI assigned
Feb 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy Physician 207KA0200X RP073528 MI Primary

Addresses

Primary practice location

833 Laurence Ave
Jackson, MI 49202-2981

Mailing address

49 S Cass St
Suite 1B
Battle Creek, MI 49017-2331
Phone (269) 969-8920

Other identifiers 1

IdentifierTypeStateIssuer
104078155MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20050419001216 MI Practitioner - Allergy/ImmunologyPractitioner - Internal Medicine 2365489788 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Allergy/ImmunologyAlso: Internal Medicine
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Asthma Allergy Centers PCGroup PAC ID 9931146347, 9 clinicians
Dr Ridhu C Burton MD PCGroup PAC ID 2365407897, 2 clinicians

Practice addresses (Care Compare)

126 College St
Battle Creek, MI 49037-3461
Phone (269) 968-3030

1324 W Milham Ave
Suite 1
Portage, MI 49024-2239
Phone (269) 342-0196

360 E Chicago St
Suite 109
Coldwater, MI 49036-2074
Phone (517) 278-9025

4169 Legacy Pkwy
Lansing, MI 48911-4200
Phone (517) 394-6500

833 Laurence Ave
Jackson, MI 49202-2981
Phone (517) 782-1700

Hospital & facility affiliations

  • Henry Ford Allegiance Health Hospital, Jackson, MI, CCN 230092
  • Insight Hospital and Medical Center Coldwater Hospital, Coldwater, MI, CCN 230022
  • Edward W Sparrow Hospital Hospital, Lansing, MI, CCN 230230

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RP073528MIMDAllergy Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dr Ridhu C Burton MD PC Allergy & Immunology CurrentSince Mar 1, 2015 Accepting new patients
Arthritis and Rheumatology Center of Hillsdale PC PastSince Apr 18, 2005 Accepting new patients
Pradhan Center for Women PLC PastSince Apr 18, 2005 Accepting new patients

Locations

4169 Legacy Pkwy
Lansing, MI 48911
Phone (517) 393-4200

4169 Legacy Pkwy
#C
Lansing, MI 48911
Phone (517) 394-6500

Interoperability endpoints

  • Direct secure messaging: rpolasani462889@direct.hfhs.org

Organizations & group practices 4

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.

Hospital & facility affiliations 4

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": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422489600000",
    "number": "1376517359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 S CASS ST",
            "address_2": "SUITE 1B",
            "city": "BATTLE CREEK",
            "state": "MI",
            "postal_code": "490172331",
            "telephone_number": "269-969-8920",
            "fax_number": "269-969-8921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 LAURENCE AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492022981",
            "telephone_number": "517-782-1700",
            "fax_number": "517-787-9512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLASANI",
        "first_name": "RAVINDER",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-15",
        "last_updated": "2015-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "MI",
            "license": "RP073528",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104078155",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

Verify at the official NPI Registry.