Individual provider Active NPI

Sridhar R Vennamaneni, MD

  • Internal Medicine Physician
  • West Palm Beach, FL
National Provider Identifier
1578548525
Registry record updated Sep 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME0082320 Issued in FL
Practice address
1552 Palm Beach Lakes Blvd
West Palm Beach, FL 33401-2302
Phone
(561) 659-7411
Fax
(561) 659-7423
NPI assigned
Dec 13, 2005
Last updated
Sep 10, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME0082320 FL Primary

Addresses

Primary practice location

1552 Palm Beach Lakes Blvd
West Palm Beach, FL 33401-2302

Mailing address

1552 Palm Beach Lakes Blvd
West Palm Beach, FL 33401-2302
Phone (561) 659-7411

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20050223000725 FL Practitioner - Internal MedicinePractitioner - General Practice 1759334378 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME0082320FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Flagler Medical Associates PA Internal Medicine CurrentSince Mar 1, 2010 Accepting new patients
Boca Medical Specialists, Inc Internal Medicine Past Accepting new patients
Conviva Medical Center Management LLC Internal Medicine Past Accepting new patients

Locations

1309 N Flagler Dr
West Palm Beach, FL 33401
Phone (561) 650-6309

1552 Palm Beach Lakes Blvd
West Palm Beach, FL 33401
Phone (561) 659-7411

300 Executive Center Dr
West Palm Beach, FL 33401
Phone (561) 471-5566

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GIFIBA

Organizations & group practices 3

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": "1134432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378771200000",
    "number": "1578548525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1552 PALM BEACH LAKES BLVD",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334012302",
            "telephone_number": "561-659-7411",
            "fax_number": "561-659-7423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1552 PALM BEACH LAKES BLVD",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334012302",
            "telephone_number": "561-659-7411",
            "fax_number": "561-659-7423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENNAMANENI",
        "first_name": "SRIDHAR",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-13",
        "last_updated": "2013-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME0082320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Palm Beach, FL

Sources for this page

Verify at the official NPI Registry.