Active NPI
Sreehari Sivasubramanian
- Physical Therapist
- Grand Rapids, MI
National Provider Identifier
1619126265
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501012811
- Practice address
- 1960 28TH St SE
Suite B
Grand Rapids, MI 49508-7900 - Phone
- (616) 475-9888
- Fax
- (616) 475-9889
- NPI assigned
- Sep 18, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501012811 | MI | Primary |
Addresses
Primary practice location
1960 28TH St SE
Suite B
Grand Rapids, MI 49508-7900
Mailing address
1960 28TH St SE
Suite B
Grand Rapids, MI 49508-7900
Phone (616) 475-9888
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501012811 | MI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Diamond Home Care Services, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Home Health Agency
- Grand Rapids, MI
- NPI 1902947930
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221696000000",
"number": "1619126265",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1960 28TH ST SE",
"address_2": "SUITE B",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495087900",
"telephone_number": "616-475-9888",
"fax_number": "616-475-9889"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1960 28TH ST SE",
"address_2": "SUITE B",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495087900",
"telephone_number": "616-475-9888",
"fax_number": "616-475-9889"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIVASUBRAMANIAN",
"first_name": "SREEHARI",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-09-18",
"last_updated": "2008-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501012811",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.