NPIMap

Individual provider Active NPI

Chandra S Reddivari, MD

  • Internal Medicine Physician
  • North Dartmouth, MA
National Provider Identifier
1477522290
Registry record updated Oct 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
152438 Issued in 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
Last updated
Oct 18, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 152438 MA Primary

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

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address creddivari6268@direct.southcoast.org

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
I20040922000870 MA Practitioner - Internal MedicinePractitioner - Emergency Medicine 8729056239 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
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 IncGroup PAC ID 0749171957, 875 clinicians

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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
152438MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southcoast Physicians Group, Inc. Internal Medicine CurrentSince Nov 1, 2012 Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Nov 1, 2012 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

480 Hawthorn St
North Dartmouth, MA 02747
Phone (508) 973-9150

500 Faunce Corner Rd
North Dartmouth, MA 02747
Phone (508) 973-2216

500 Faunce Corner Rd
Ste 170
North Dartmouth, MA 02747
Phone (508) 973-2216

Interoperability endpoints

  • Direct secure messaging: creddivari6268@direct.southcoast.org

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Southcoast Visiting Nurse Association, IncFairhaven, MA, CCN 227101 Home health agency Corporate Director Apr 1, 2022
Southcoast Visiting Nurse Association, IncFairhaven, MA, CCN 221536 Hospice Corporate Director
W-2 Managing Employee		 Apr 1, 2022
Apr 4, 2024

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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 6

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": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729209600000",
    "number": "1477522290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MILL ROAD",
            "address_2": "SUITE 180",
            "city": "FAIRHAVEN",
            "state": "MA",
            "postal_code": "027195252",
            "telephone_number": "508-973-2000",
            "fax_number": "508-973-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 FAUNCE CORNER RD",
            "city": "NORTH DARTMOUTH",
            "state": "MA",
            "postal_code": "027471278",
            "telephone_number": "508-973-3200",
            "fax_number": "508-973-3215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDDIVARI",
        "first_name": "CHANDRA",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-15",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "152438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "creddivari6268@direct.southcoast.org",
            "affiliation": "N",
            "endpointDescription": "Southcoast Health Epic Direct Address",
            "address_1": "200 Mill Road",
            "address_2": "Suite 190",
            "city": "Fairhaven",
            "state": "MA",
            "country_code": "US",
            "postal_code": "027195252",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in North Dartmouth, MA

Sources for this page

Verify at the official NPI Registry.