NPIMap

Individual provider Active NPI

Raghu D Ganjam, M.D.

  • Internal Medicine Physician
  • Orlando, FL
National Provider Identifier
1558304261
Registry record updated Jul 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME87933 Issued in FL
Practice address
1507 S Hiawassee Rd
Suite 107
Orlando, FL 32835-5718
Phone
(407) 445-9545
Fax
(407) 445-9365
NPI assigned
Jun 13, 2006
Last updated
Jul 13, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME87933 FL Primary
Addiction Medicine (Internal Medicine) Physician 207RA0401X ME87933 FL

Addresses

Primary practice location

1507 S Hiawassee Rd
Suite 107
Orlando, FL 32835-5718

Mailing address

1507 S Hiawassee Rd
Suite 107
Orlando, FL 32835-5718
Phone (407) 445-9545

Other identifiers 1

IdentifierTypeStateIssuer
268463200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20040129000355 FL Practitioner - Internal MedicinePractitioner - Addiction Medicine 7315840188 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Addiction Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Med-Psych Consultants LLCGroup PAC ID 5799115713, 20 clinicians
Orlando Inpatient Medicine PAGroup PAC ID 0749598316, 54 clinicians

Practice addresses (Care Compare)

1507 S Hiawassee Rd
Suite 206
Orlando, FL 32835-5719
Phone 4074459545222

601 E Rollins St
Orlando, FL 32803-1248
Phone (407) 445-9545

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20188OKMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Med-Psych Consultants LLC CurrentSince Jan 13, 2020 Accepting new patients
Orlando Inpatient Medicine, PA Internal Medicine CurrentSince Sep 1, 2015 Accepting new patients
Morton Comprehensive Health Services, Inc Family Medicine Past Accepting new patients

Locations

525 Technology Park
Ste 109
Lake Mary, FL 32746
Phone 4076472346 ext. 111

1507 S Hiawassee Rd
Ste 107
Orlando, FL 32835
Phone (407) 445-9545

1507 S Hiawassee Rd
Ste 206
Orlando, FL 32835
Phone (407) 445-9545

601 E Rollins St
Orlando, FL 32803
Phone (407) 303-1996

6601 Central Florida Pkwy
Orlando, FL 32821
Phone (407) 370-0111

Interoperability endpoints

  • Direct secure messaging: raghuganjam@oim.allscriptsdirect.net

Organizations & group practices 4

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": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657670400000",
    "number": "1558304261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1507 S HIAWASSEE RD",
            "address_2": "SUITE 107",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328355718",
            "telephone_number": "407-445-9545",
            "fax_number": "407-445-9365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1507 S HIAWASSEE RD",
            "address_2": "SUITE 107",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328355718",
            "telephone_number": "407-445-9545",
            "fax_number": "407-445-9365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANJAM",
        "first_name": "RAGHU",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2022-07-13",
        "certification_date": "2022-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME87933",
            "primary": true
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "FL",
            "license": "ME87933",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "268463200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.