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Individual provider Active NPI

Prema Siva, MD

  • Internal Medicine Physician
  • Laurel, MD
National Provider Identifier
1699722009
Registry record updated Apr 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D66419 Issued in MD
Practice address
8871 Gorman Rd Ste 300
Laurel, MD 20723-5877
Phone
(410) 498-3150
Fax
(410) 601-8886
NPI assigned
May 30, 2006
Last updated
Apr 4, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 186016 NY
Internal Medicine Physician 207R00000X D66419 MD Primary

Addresses

Primary practice location

8871 Gorman Rd Ste 300
Laurel, MD 20723-5877

Mailing address

8871 Gorman Rd Ste 300
Laurel, MD 20723-5877
Phone (410) 498-3150

Other practice location 1

640 Hawkins Ave
Lake Ronkonkoma, NY 11779-2324
Phone (631) 737-0100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090113000155 MD Practitioner - Internal Medicine 8022171370 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Agape Physical Therapy and Sports Rehabilitation LPGroup PAC ID 3870741390, 684 clinicians

Practice addresses (Care Compare)

12 Newport Dr
Suite a
Forest Hill, MD 21050-1758

2401 E Belvedere Ave
Baltimore, MD 21215-5216

410 Malcolm Dr
Suite a
Westminster, MD 21157-6160
Phone (410) 876-7772

8871 Gorman Rd
Laurel, MD 20723-5877
Phone (301) 498-3150

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D66419MDMDInternal Medicine Physician
186016NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lifebridge Community Physicians, Inc Current Accepting new patients
Lifebridge Community Physicians, Inc Internal Medicine CurrentSince Jan 1, 2014 Accepting new patients
Lifebridge Community Physicians Inc CurrentSince Jan 1, 2014 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Queens Long Island Medical Group, P.C. Internal Medicine Past Accepting new patients

Locations

8871 Gorman Rd
Ste 300
Laurel, MD 20723
Phone (301) 498-3150

9649 Belair Rd
Fl 2
Nottingham, MD 21236
Phone (410) 256-9340

410 Malcolm Dr
Ste A
Westminster, MD 21157
Phone (410) 876-1633

Organizations & group practices 6

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.

Hospital & facility affiliations 3

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": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712188800000",
    "number": "1699722009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8871 GORMAN RD STE 300",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207235877",
            "telephone_number": "410-498-3150",
            "fax_number": "410-601-8886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8871 GORMAN RD STE 300",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207235877",
            "telephone_number": "410-498-3150",
            "fax_number": "410-601-8886"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "640 Hawkins Ave",
            "address_purpose": "LOCATION",
            "city": "Lake Ronkonkoma",
            "state": "NY",
            "postal_code": "117792324",
            "country_code": "US",
            "telephone_number": "631-737-0100",
            "fax_number": "631-417-1117",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIVA",
        "first_name": "PREMA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-30",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "186016",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D66419",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MD

Sources for this page

Verify at the official NPI Registry.