Chandra S Reddivari, MD
Individual provider Active NPI Internal Medicine Physician · North Dartmouth, MA
NPI 1477522290 · NPPES record last updated Oct 18, 2024
Key facts
- NPI
- 1477522290
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 152438 (MA)
- Practice address
- 500 Faunce Corner Rd
North Dartmouth, MA 02747-1278 - Phone
- (508) 973-3200
- Fax
- (508) 973-3215
- NPI assigned
- Mar 15, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 6
Owned or controlled facilities with NPI records 2
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Other, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Southcoast Physicians Group Inc
Practice addresses (Care Compare)
101 Page St
New Bedford, MA 02740-3464
Phone (508) 973-5919
200 Mill Rd
Suite 190
Fairhaven, MA 02719-5259
Phone (508) 973-0857
300 A Faunce Corner Rd
North Dartmouth, MA 02747-1280
363 Highland Ave
Fall River, MA 02720-3703
Phone (508) 973-5919
534 Prospect St
Fall River, MA 02720-5281
Phone (508) 973-7766
Hospital & facility affiliations
- Southcoast Visiting Nurse Association Inc
- Nightingale Visiting Nurses
- Community Nurse Home Care
- Hospice and Palliative Care
- Southcoast Hospitals Group
- Clifton Rehabilitation Nursing Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Southcoast Visiting Nurse Association, Inc |
Home health agency | Corporate Director | Apr 1, 2022 |
| Southcoast Visiting Nurse Association, Inc |
Hospice | Corporate Director W-2 Managing Employee |
Apr 1, 2022 Apr 4, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040922000870 | MA | Practitioner - Internal Medicine |
8729056239 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 152438 | MA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southcoast Physicians Group, Inc. | Internal Medicine | Current |
Accepting new patients |
| Southcoast Physicians Group, Inc. | Current |
Accepting new patients |
Locations
200 Mill Rd
Ste 180
Fairhaven, MA 02719
Phone (508) 973-2000
200 Mill Rd
Ste 190
Fairhaven, MA 02719
Phone (508) 973-0857
534 Prospect St
Fall River, MA 02720
Phone (508) 679-7766
237 State Rd
#A
North Dartmouth, MA 02747
Phone (413) 263-1027
500 Faunce Corner Rd
Ste 170
North Dartmouth, MA 02747
Phone (508) 973-2216
500 Faunce Corner Rd
North Dartmouth, MA 02747
Phone (508) 973-2216
480 Hawthorn St
North Dartmouth, MA 02747
Phone (508) 973-9150
Interoperability endpoints
- creddivari6268@direct.southcoast.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 152438 | MA | Yes |
Addresses
Primary practice location
500 Faunce Corner Rd
North Dartmouth, MA 02747-1278
Mailing address
200 Mill Road
Suite 180
Fairhaven, MA 02719-5252
Phone (508) 973-2000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 177806 | Medicaid | MA |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | creddivari6268@direct.southcoast.org |
Other providers in North Dartmouth, MA
- Quest Diagnostics LLC
- R.Mangapit Jr&E. Olegario Dmdpc
- Chelsea Marie Ramos
- Thembi Ranuga
- Megan Leigh Raposa
- Melissa Regan
- Richard W. Reimer
- Renee B Reis
- Richard S. Fox, M.D., P.C.
- Alyse Richard
All providers in North Dartmouth, MA · Internal Medicine Physician in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.