Individual provider Active NPI

Shashidhara Nanjundaswamy, MD

  • Neurology Physician
  • Worcester, MA
National Provider Identifier
1518930486
Registry record updated Apr 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
225327 Issued in MA
Practice address
123 Summer St
Suite 230S
Worcester, MA 01608-1216
Phone
(508) 368-3150
Fax
(508) 368-3152
NPI assigned
Feb 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 225327 MA Primary

Addresses

Primary practice location

123 Summer St
Suite 230S
Worcester, MA 01608-1216

Mailing address

630 Plantation St
Wot 12TH FL
Worcester, MA 01605-2038
Phone (508) 368-5532

Other identifiers 1

IdentifierTypeStateIssuer
2115646MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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

Enrollment IDStateProvider typePAC IDDetails
I20060817000460 MA Practitioner - NeurologyPractitioner - Other (Physician) 1456354190 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Reliant Medical Group IncGroup PAC ID 5597755322, 638 clinicians

Practice addresses (Care Compare)

123 Summer St
Worcester, MA 01608-1216
Phone (508) 363-5000

Hospital & facility affiliations

  • St Vincent Hospital Hospital, Worcester, MA, CCN 220176
  • Umass Memorial Healthalliance Hospitals Hospital, Leominster, MA, CCN 220001
  • Umass Memorial Medical Center/University Campus Hospital, Worcester, MA, CCN 220163

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Reliant Medical Group, Inc CurrentSince Mar 31, 2014 Accepting new patients
Reliant Medical Group, Inc Past Accepting new patients

Locations

123 Summer St
Worcester, MA 01608
Phone (508) 363-6000

5 Neponset St
Worcester, MA 01606
Phone (508) 595-2300

123 Summer St
Ste 230S
Worcester, MA 01608
Phone (508) 368-3150

630 Plantation St
Fl 12
Worcester, MA 01605
Phone (508) 368-5529

Interoperability endpoints

  • Direct secure messaging: shashidhara.nanjundaswamy.npi1518930486.reliant@direct.optumcare.masshiway.net

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397088000000",
    "number": "1518930486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 PLANTATION ST",
            "address_2": "WOT 12TH FL",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052038",
            "telephone_number": "508-368-5532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 SUMMER ST",
            "address_2": "SUITE 230S",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016081216",
            "telephone_number": "508-368-3150",
            "fax_number": "508-368-3152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NANJUNDASWAMY",
        "first_name": "SHASHIDHARA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-09",
        "last_updated": "2014-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MA",
            "license": "225327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2115646",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.