Individual provider Active NPI

Jeevarathi Gnanaratnem, M.D.

  • Neonatal-Perinatal Medicine Physician
  • San Diego, CA
National Provider Identifier
1467523225
Registry record updated Dec 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
A61624 Issued in CA
Practice address
3003 Health Center Dr
San Diego, CA 92123-2700
Phone
(858) 939-4185
NPI assigned
Nov 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A61624 CA
Neonatal-Perinatal Medicine Physician 2080N0001X A61624 CA Primary

Addresses

Primary practice location

3003 Health Center Dr
San Diego, CA 92123-2700

Mailing address

8555 Aero Drive, Suite 104
San Diego, CA 92123
Phone (858) 384-7828

Other identifiers 1

IdentifierTypeStateIssuer
00A616240MedicaidCA

Other names 1

  • Jeevarathi Seevaratnam Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20130829000338 CA Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 2365685930

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A61624CAMDNeonatal-Perinatal Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386720000000",
    "number": "1467523225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8555 AERO DRIVE, SUITE 104",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92123",
            "telephone_number": "858-384-7828",
            "fax_number": "858-598-6344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 HEALTH CENTER DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921232700",
            "telephone_number": "858-939-4185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GNANARATNEM",
        "first_name": "JEEVARATHI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2013-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A61624",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "CA",
            "license": "A61624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A616240",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEEVARATHI",
            "last_name": "SEEVARATNAM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.