Individual provider Active NPI

Channarayapatna R. Sridhara, MD

  • Physical Medicine & Rehabilitation Physician
  • Philadelphia, PA
National Provider Identifier
1407800022
Registry record updated Aug 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
MD037374L Issued in PA
Practice address
101 E Olney Ave
Suite 400
Philadelphia, PA 19120-2421
Phone
(215) 456-7000
Fax
(215) 254-2599
NPI assigned
May 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X MD037374L PA Primary

Addresses

Primary practice location

101 E Olney Ave
Suite 400
Philadelphia, PA 19120-2421

Mailing address

60 Township Line Rd
Elkins Park, PA 19027-2220
Phone (215) 663-6677

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20110505000691 PA Practitioner - Physical Medicine and Rehabilitation 0648455642 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Einstein Practice Plan IncGroup PAC ID 2769395896, 774 clinicians

Practice addresses (Care Compare)

1200 W Tabor Rd
Philadelphia, PA 19141-3019

1200 W Tabor Rd 4TH Floor
Einstein Anesthesia Assoc
Philadelphia, PA 19141-3019
Phone (215) 456-3815

50 E Township Line Rd
Medical Arts BLDG 2ND Floor
Elkins Park, PA 19027-2220
Phone (215) 663-6067

60 E Township Line Rd
Elkins Park, PA 19027-2220

60 E Townshipline Rd
Elkins Park, PA 19027-2220

Medical Arts Building G-01
Einstein Endocrinology Associates
Elkins Park, PA 19027-2220
Phone (215) 572-5200

Hospital & facility affiliations

  • Jefferson Einstein Philadelphia Hospital Hospital, Philadelphia, PA, CCN 390142

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD037374LPAMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Einstein Practice Plan Inc Current Accepting new patients
Einstein Practice Plan Inc CurrentSince Dec 6, 1979 Accepting new patients
Einstein Practice Plan Inc Physical Medicine & Rehabilitation CurrentSince Dec 6, 1979 Accepting new patients
Einstein Practice Plan Inc Past Accepting new patients

Locations

60 Township Line Rd
Elkins Park, PA 19027
Phone (215) 663-6000

5501 Old York Rd
Ste 3
Philadelphia, PA 19141
Phone (215) 456-7180

5501 York Rd
Ste 202
Philadelphia, PA 19141
Phone (215) 254-2630

101 E Olney Ave
Ste 400
Philadelphia, PA 19120
Phone (215) 254-2630

1200 W Tabor Rd
Philadelphia, PA 19141
Phone (215) 456-9470

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 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": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187222400000",
    "number": "1407800022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 TOWNSHIP LINE RD",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190272220",
            "telephone_number": "215-663-6677",
            "fax_number": "215-254-2599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E OLNEY AVE",
            "address_2": "SUITE 400",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191202421",
            "telephone_number": "215-456-7000",
            "fax_number": "215-254-2599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SRIDHARA",
        "first_name": "CHANNARAYAPATNA",
        "middle_name": "R.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2007-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "PA",
            "license": "MD037374L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.