Individual provider Active NPI

Periakaruppan Vairavan Manickam, MD

  • Neuroradiology Physician
  • Columbus, OH
National Provider Identifier
1609261395
Registry record updated May 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuroradiology PhysicianTaxonomy code 2085N0700X
License
35.152863 Issued in OH
Practice address
395 W 12TH Ave FL 4
Columbus, OH 43210-1267
Phone
(614) 293-8315
Fax
(614) 293-6935
NPI assigned
Mar 31, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 390200000X PA
Diagnostic Radiology Physician 2085R0202X A188792 CA
Neuroradiology Physician 2085N0700X 35.152863 OH Primary

Addresses

Primary practice location

395 W 12TH Ave FL 4
Columbus, OH 43210-1267

Mailing address

700 Ackerman Rd Ste 2120
Columbus, OH 43202-1559
Phone (614) 293-8315

Other practice location 1

300 Pasteur Dr
Stanford, CA 94305-2200
Phone (650) 723-4000

Other names 1

  • Vairavan Manickam Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20250603003359 OH Practitioner - Diagnostic Radiology 9032413596 Reassigns benefits to 1 organization
I20250708004222 TX Practitioner - Diagnostic Radiology 9032413596 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Cincinnati College of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osu Radiology LLCGroup PAC ID 8921031675, 180 clinicians

Practice addresses (Care Compare)

2323 N Akard St
Apt 407
Dallas, TX 75201-8474
Phone (614) 293-8315

395 W 12TH Ave
RM 460
Columbus, OH 43210-1267
Phone (614) 293-8315

801 Webb LN
Prosper, TX 75078-3295
Phone (614) 293-8315

9 Amberstone Dr
Sugar Land, TX 77479-5607
Phone (614) 293-8315

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
390200000XPAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Osu Radiology LLC Diagnostic Radiology CurrentSince May 1, 2025 Accepting new patients
Sutter Valley Medical Foundation Otolaryngology Current Accepting new patients

Locations

600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755

2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850

395 W 12th Ave
Fl 4
Columbus, OH 43210
Phone (614) 293-8369

395 W 12th Ave
Rm 460
Columbus, OH 43210
Phone (614) 293-8299

700 Ackerman Rd
Ste 2120
Columbus, OH 43202

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 7

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": "1427760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747958400000",
    "number": "1609261395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 ACKERMAN RD STE 2120",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432021559",
            "telephone_number": "614-293-8315",
            "fax_number": "614-293-6935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 W 12TH AVE FL 4",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432101267",
            "telephone_number": "614-293-8315",
            "fax_number": "614-293-6935"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Pasteur Dr",
            "address_purpose": "LOCATION",
            "city": "Stanford",
            "state": "CA",
            "postal_code": "943052200",
            "country_code": "US",
            "telephone_number": "650-723-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANICKAM",
        "first_name": "PERIAKARUPPAN",
        "middle_name": "VAIRAVAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-31",
        "last_updated": "2025-05-23",
        "certification_date": "2025-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "PA",
            "license": "390200000X",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A188792",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "OH",
            "license": "35.152863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VAIRAVAN",
            "last_name": "MANICKAM",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.