Individual provider Active NPI

Pavan Kumar Ravipati, M.D.

  • Internal Medicine Physician
  • Warren, MI
National Provider Identifier
1427686716
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME168084 Issued in FL
Practice address
11800 E 12 Mile Rd
Warren, MI 48093-3472
Phone
(248) 967-7123
NPI assigned
Mar 31, 2020
Last updated
Dec 16, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Internal Medicine Physician 207R00000X ME168084 FL Primary

Addresses

Primary practice location

11800 E 12 Mile Rd
Warren, MI 48093-3472

Mailing address

12000 E 12 Mile Rd
Warren, MI 48093-3570
Phone (248) 967-7123

Other practice location 1

15255 Max Leggett Pkwy
Jacksonville, FL 32218-7273
Phone (904) 427-0411

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20250101000043 FL Practitioner - Internal Medicine 9032501366 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sound Physicians of Florida VI LLCGroup PAC ID 1759802333, 141 clinicians

Practice addresses (Care Compare)

4725 N Federal Hwy
Fort Lauderdale, FL 33308-4603
Phone (954) 771-8000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Cogent Healthcare of Jacksonville, LLC Internal Medicine Current Accepting new patients
Sound Physicians of Florida VI LLC Internal Medicine CurrentSince Feb 1, 2025 Accepting new patients
Cogent Healthcare of Jacksonville, LLC Internal Medicine CurrentSince Nov 19, 2024 Accepting new patients
Cogent Healthcare of Jacksonville, LLC Internal Medicine CurrentSince Nov 19, 2024 Accepting new patients
Henry Ford Health Macomb-Oakland Hospital PastSince Apr 5, 2020 Accepting new patients

Locations

15255 Max Leggett Pkwy
Jacksonville, FL 32218
Phone (904) 383-1000

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

655 W 8th St
Ste CC262
Jacksonville, FL 32209

4725 N Federal Hwy
Oakland Park, FL 33308
Phone (954) 493-5005

120 Brentwood Commons Way
Ste 510
Brentwood, TN 37027
Phone (253) 682-6040

Interoperability endpoints

  • Direct secure messaging: pravipati733538@direct.shands.ufl.edu

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1585612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734307200000",
    "number": "1427686716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12000 E 12 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933570",
            "telephone_number": "248-967-7123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11800 E 12 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933472",
            "telephone_number": "248-967-7123"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15255 Max Leggett Pkwy",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322187273",
            "country_code": "US",
            "telephone_number": "904-427-0411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAVIPATI",
        "first_name": "PAVAN",
        "middle_name": "KUMAR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-31",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME168084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

Verify at the official NPI Registry.