Active NPI
Pranav Bollavaram
- Student in an Organized Health Care Education/Training Program
- Columbus, OH
National Provider Identifier
1629658133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 395 W 12TH Ave
Columbus, OH 43210-1267 - Phone
- (614) 685-4411
- NPI assigned
- Apr 9, 2021
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
395 W 12TH Ave
Columbus, OH 43210-1267
Mailing address
395 W 12TH Ave
Columbus, OH 43210-1267
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260623000227 | NY | Practitioner - Physical Medicine and Rehabilitation | 3173921756 |
Care Compare profile
Medicare Care Compare- Specialty
- Physical Medicine and Rehabilitation
- Education
- Northeastern Ohio University College of Medicine, 2021
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1111 Marcus Ave
New Hyde Park, NY 11042-1034
2 Brighton Rd
Suite 300
Clifton, NJ 07012-1645
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659916800000",
"number": "1629658133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "395 W 12TH AVE",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432101267"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "395 W 12TH AVE",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432101267",
"telephone_number": "614-685-4411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLLAVARAM",
"first_name": "PRANAV",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-04-09",
"last_updated": "2022-08-08",
"certification_date": "2022-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.