Dr Siruvella MD PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

057019 Issued in GA

Legal business name

DR SIRUVELLA MD PC

Practice address

705 Breedlove Dr
Suite 800
Monroe, GA 30655-2090

Phone

(770) 266-0567

NPI assigned

Sep 9, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Sridevi Siruvella, MDNPI 1164483871

Title

Medical Director/Physician

Phone

(770) 266-0567

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sridevi Siruvella, M.D.

  • Family Medicine Physician
  • Monroe, GA
  • NPI 1164483871
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1283990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284076800000",
    "number": "1447567631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 BREEDLOVE DR",
            "address_2": "SUITE 800",
            "city": "MONROE",
            "state": "GA",
            "postal_code": "306552090",
            "telephone_number": "770-266-0567",
            "fax_number": "770-266-0507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 BREEDLOVE DR",
            "address_2": "SUITE 800",
            "city": "MONROE",
            "state": "GA",
            "postal_code": "306552090",
            "telephone_number": "770-266-0567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR SIRUVELLA MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-09",
        "last_updated": "2010-09-10",
        "status": "A",
        "authorized_official_last_name": "SIRUVELLA",
        "authorized_official_first_name": "SRIDEVI",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR/PHYSICIAN",
        "authorized_official_telephone_number": "770-266-0567",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "057019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "057019",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Monroe, GA
• Providers in Monroe, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.