Raghuram Prasad, MD
Individual provider Active NPI Child & Adolescent Psychiatry Physician · Philadelphia, PA
NPI 1508068081 · NPPES record last updated Jan 9, 2017
Key facts
- NPI
- 1508068081
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Child & Adolescent Psychiatry Physician 2084P0804X
- License
- MD443889 (PA)
- Practice address
- 3401 Civic Center Blvd
Philadelphia, PA 19104-4319 - Phone
- (215) 590-7555
- NPI assigned
- Jun 5, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
3401 Civic Ctr Blvd
Philadelphia, PA 19104
3401 Civic Ctr Blvd
Philadelphia, PA 19104-4319
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260521001410 | PA | Practitioner - Psychiatry | 8921190422 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-116935 | IL | MD | Psychiatry Physician |
| 2007015932 | MO | MD | Child & Adolescent Psychiatry Physician |
| MD443889 | PA | MD | Child & Adolescent Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ozarks Medical Center | Past | Accepting new patients | |
| Comprehensive Health Systems, Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | MD443889 | PA | Yes |
| Psychiatry Physician | 2084P0800X | 036-116935 | IL | |
| Psychiatry Physician | 2084P0800X | 2007015932 | MO | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | 2007015932 | MO |
Addresses
Primary practice location
3401 Civic Center Blvd
Philadelphia, PA 19104-4319
Mailing address
100 E Penn SQ
6TH Floor Wanamaker Building
Philadelphia, PA 19107-3323
Phone (215) 590-6267
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036116935 | Medicaid | IL | |
| 036-116935 | Other | IL | PHYSICIAN LICENSE |
| 732001 | Other | IA | BLUE CROSS BLUE SHIELD |
Other providers in Philadelphia, PA
- Allyson Theresa Prasad
- Aman Prasad
- Dilan Prasad
- Nandan Prasad
- Ojaswa Prasad
- Ranjoo K Prasad
- Sandhya Prasad
- Sashank Prasad
- Srinivas Kasinadhuni Prasad
- Sushama Prasad
All providers in Philadelphia, PA · Child & Adolescent Psychiatry Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2017. 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.
- 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.