NPIMap

Individual provider Active NPI

Sambasivarao Venkata Karanam, MD

  • General Practice Physician
  • South Bend, WA
National Provider Identifier
1487673679
Registry record updated Mar 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
MD00021462 Issued in WA
Practice address
827 E. Water St.,
# B
South Bend, WA 98586-1166
Phone
(425) 766-1614
NPI assigned
Jul 19, 2006
Last updated
Mar 11, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 11, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X MD00021462 WA Primary

Addresses

Primary practice location

827 E. Water St.,
# B
South Bend, WA 98586-1166

Mailing address

PO Box 1166
827 E. Water Street # B
South Bend, WA 98586-1166
Phone (425) 766-1614

Other identifiers 1

IdentifierTypeStateIssuer
7105240MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00021462WAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital District No 4, King County Wa Past Accepting new patients
Franciscan Medical Group Past Accepting new patients
Pacific County Hospital District 2 Past Accepting new patients
South Hill General Medical Clinic General Practice PastSince Oct 10, 2015 Accepting new patients
Mso Washington, Inc. Past Accepting new patients
Public Hospital District No 4 King County Washington Past Accepting new patients
Meridian Medical Clinic, LLC PastSince Jan 1, 2004 Accepting new patients

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299801600000",
    "number": "1487673679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1166",
            "address_2": "827 E. WATER STREET # B",
            "city": "SOUTH BEND",
            "state": "WA",
            "postal_code": "985861166",
            "telephone_number": "425-766-1614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "827 E. WATER ST.,",
            "address_2": "# B",
            "city": "SOUTH BEND",
            "state": "WA",
            "postal_code": "985861166",
            "telephone_number": "425-766-1614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KARANAM",
        "first_name": "SAMBASIVARAO",
        "middle_name": "VENKATA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2011-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WA",
            "license": "MD00021462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7105240",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.