Active NPI
Roshan Sivagnanam, M.D.
- Diagnostic Radiology Physician
- Rutland, VT
National Provider Identifier
1679611552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 042-0007282
- Practice address
- 160 Allen St
Rutland, VT 05701-4560 - Phone
- (802) 747-3650
- NPI assigned
- Feb 2, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 042-0007282 | VT | Primary |
Addresses
Primary practice location
160 Allen St
Rutland, VT 05701-4560
Mailing address
160 Allen St
Rutland, VT 05701-4560
Phone (802) 747-3650
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0006373 | Medicaid | VT |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042-0007282 | VT | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452297600000",
"number": "1679611552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "160 ALLEN ST",
"city": "RUTLAND",
"state": "VT",
"postal_code": "057014560",
"telephone_number": "802-747-3650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 ALLEN ST",
"city": "RUTLAND",
"state": "VT",
"postal_code": "057014560",
"telephone_number": "802-747-3650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIVAGNANAM",
"first_name": "ROSHAN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-02",
"last_updated": "2016-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "VT",
"license": "042-0007282",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0006373",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rutland, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.