NPIMap

Individual provider Active NPI

Ravi Varma Gottumukkala, M.D.

  • Diagnostic Radiology Physician
  • Boston, MA
National Provider Identifier
1467866129
Registry record updated May 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
273231 Issued in MA
Practice address
55 Fruit St.
Radiology
Boston, MA 02114
Phone
(630) 291-9085
NPI assigned
Jun 19, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 273231 MA Primary

Addresses

Primary practice location

55 Fruit St.
Radiology
Boston, MA 02114

Mailing address

4 Longfellow PL Apt 2009
Boston, MA 02114-2817
Phone (630) 291-9085

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190606001258 MA Practitioner - Diagnostic Radiology 4789990557 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Washington University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

75 Francis St
Boston, MA 02115-6110
Phone (617) 732-5500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
273231MAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Brigham & Womens Physicians Organization Inc CurrentSince Jul 1, 2020 Accepting new patients
Mass General Brigham Medical Group Western Massachusetts Inc CurrentSince Oct 13, 2020 Accepting new patients
Harbor Medical Associates, Inc. CurrentSince Aug 5, 2020 Accepting new patients
Cooley Dickinson Hospital Inc CurrentSince Jan 19, 2021 Accepting new patients
Brigham and Women'S Hospital Current Accepting new patients
Hampshire Pathologists, Inc. Current Accepting new patients
Mass General Brigham Medical Group Suburban Massachusetts Inc CurrentSince Oct 1, 2020 Accepting new patients
Harbor Medical Associates, Inc. CurrentSince Jan 1, 2020 Accepting new patients
Cooley Dickinson Hospital Inc CurrentSince Jan 19, 2021 Accepting new patients
Harbor Medical Associates, Inc. Diagnostic Radiology CurrentSince Aug 5, 2020 Accepting new patients
Mass General Brigham Medical Group Western Massachusetts Inc Past Accepting new patients

Locations

75 Francis St
Boston, MA 02115

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

1153 Centre St
Jamaica Plain, MA 02130
Phone (617) 983-7000

2014 Washington St
Newtonville, MA 02462
Phone (617) 243-6000

30 Locust St
Northampton, MA 01060
Phone (413) 582-2000

12 College Hwy
Southampton, MA 01073
Phone (413) 527-1105

541 Main St
Ste 314
Weymouth, MA 02190
Phone (781) 952-1200

Interoperability endpoints

  • Direct secure messaging: ravi.gottumukkala.1@30093.direct.athenahealth.com
  • Direct secure messaging: gottumukkala.ravi.bwh@direct.partners.masshiway.net

Organizations & group practices 11

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 7

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": "1403136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557273600000",
    "number": "1467866129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 LONGFELLOW PL APT 2009",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142817",
            "telephone_number": "630-291-9085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST.",
            "address_2": "RADIOLOGY",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02114",
            "telephone_number": "630-291-9085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOTTUMUKKALA",
        "first_name": "RAVI",
        "middle_name": "VARMA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-19",
        "last_updated": "2019-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MA",
            "license": "273231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.