Praveen Rajanahalli, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

01067143A Issued in IN

Practice address

701 E County Line Rd Ste 210
Greenwood, IN 46143

Phone

(317) 300-7424

Fax

(317) 300-7976

NPI assigned

Mar 5, 2008

Last updated

Apr 1, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Altus Direct, LLC

  dba Supro Direct

  • Family Medicine Physician
  • Greenwood, IN
  • NPI 1750829230
  Authorized official Same address or phone
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

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

{
    "created_epoch": "1204675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554076800000",
    "number": "1497925572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 E COUNTY LINE RD STE 210",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461431071",
            "telephone_number": "317-300-7424",
            "fax_number": "317-300-7976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 E COUNTY LINE RD STE 210",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "46143",
            "telephone_number": "317-300-7424",
            "fax_number": "317-300-7976"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8921 Southpointe Dr",
            "address_2": "Suite A-1",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462271084",
            "country_code": "US",
            "telephone_number": "317-884-7820",
            "fax_number": "317-888-8851",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAJANAHALLI",
        "first_name": "PRAVEEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-05",
        "last_updated": "2019-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IN",
            "license": "11013162A",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IN",
            "license": "01067143A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200961530",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Rafferty
• Ragan Psychological Associates of Greenwood (Ragan Psychological Associates)
• Courtney Ragan
• Morgan Tyler Ragan, NP
• Layla Amber Rainbolt, LMHC
• Minesh Dinesh Rajkotia, M.D.
• Emily Christine Rake
• Maryssa Rakow
• Natalie Grissom Raleigh, M.A., CCC-SLP
• Lisa Ramey, RBT

• General Practice Physician in Greenwood, IN
• Providers in Greenwood, IN by specialty
• General Practice Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.