Individual provider Active NPI

Guru Nandha Raja Chinnaraj, M.D.

  • Student in an Organized Health Care Education/Training Program
  • Orlando, FL
National Provider Identifier
1710515408
Registry record updated Jun 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
6850 Lake Nona Boulevard
Orlando, FL 32827
Phone
(407) 226-1106
Fax
(407) 518-3923
NPI assigned
Mar 30, 2020
Last updated
Jun 2, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2025

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 ME166955 FL
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

6850 Lake Nona Boulevard
Orlando, FL 32827

Mailing address

6850 Lake Nona Boulevard
Orlando, FL 32827
Phone (407) 226-1106

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20250704000034 FL Practitioner - Internal Medicine 4284172966 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ridgewood Physician Services, LLCGroup PAC ID 0446594105, 47 clinicians

Practice addresses (Care Compare)

40100 Hwy 27
Davenport, FL 33837-5906
Phone (863) 422-4971

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ridgewood Physician Services, LLC CurrentSince Jun 1, 2025 Accepting new patients

Locations

40100 Highway 27
Davenport, FL 33837
Phone (863) 419-2496

200 Corporate Blvd
Lafayette, LA 70508

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, 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": "1585526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748822400000",
    "number": "1710515408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6850 LAKE NONA BOULEVARD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "32827",
            "telephone_number": "407-226-1106",
            "fax_number": "407-518-3923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6850 LAKE NONA BOULEVARD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "32827",
            "telephone_number": "407-226-1106",
            "fax_number": "407-518-3923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHINNARAJ",
        "first_name": "GURU NANDHA RAJA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-30",
        "last_updated": "2025-06-02",
        "certification_date": "2025-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME166955",
            "primary": false
        },
        {
            "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 Orlando, FL

Sources for this page

Verify at the official NPI Registry.