NPIMap

Individual provider Active NPI

Ravikumar R Peddireddy, MD

  • Internal Medicine Physician
  • Flint, MI
National Provider Identifier
1710989546
Registry record updated Dec 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301058453 Issued in MI
Practice address
G1071 N Ballenger Hwy
Suite 206
Flint, MI 48504-4453
Phone
(810) 234-1651
Fax
(810) 257-0694
NPI assigned
Aug 11, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301058453 MI Primary

Addresses

Primary practice location

G1071 N Ballenger Hwy
Suite 206
Flint, MI 48504-4453

Mailing address

G1071 N Ballenger Hwy
Suite 206
Flint, MI 48504-4453
Phone (810) 234-1651

Other identifiers 1

IdentifierTypeStateIssuer
3054785MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20080529000682 MI Practitioner - Internal Medicine 5799855045 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Premier Medical Clinics PCGroup PAC ID 0941340665, 10 clinicians
Rau Physical Therapy IncGroup PAC ID 2365721339, 98 clinicians

Practice addresses (Care Compare)

1165 S Linden Rd
Flint, MI 48532-3406

1165 S Linden Rd St a
Flint, MI 48532-3406
Phone (810) 732-5400

193 E Jefferson St
Frankenmuth, MI 48734-1935

G-1071 N Ballenger Hwy 206
Flint, MI 48504-4453
Phone (810) 234-1651

Hospital & facility affiliations

  • Ideal Home Health Services, LLC Home health agency, Grand Blanc, MI, CCN 239158
  • Residential Home Health and Hospice Home health agency, Lapeer, MI, CCN 237495
  • McLaren Home Health Home health agency, Davison, MI, CCN 237010
  • Centerwell Home Health Home health agency, Flint, MI, CCN 237136
  • McLaren Flint Hospital, Flint, MI, CCN 230141
  • Hurley Medical Center Hospital, Flint, MI, CCN 230132
  • University of Michigan Health System Hospital, Ann Arbor, MI, CCN 230046

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301058453MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Medical Clinics PC CurrentSince Jan 2, 2010 Accepting new patients
CT Center of Flint, PLLC Past Accepting new patients

Locations

G1071 N Ballenger Hwy
Ste 206
Flint, MI 48504
Phone (810) 234-1651

1165 S Linden Rd
#A
Flint, MI 48532
Phone (810) 732-5400

1 Hurley Plz
Flint, MI 48503
Phone (810) 257-9000

401 S Ballenger Hwy
Fl 5
Flint, MI 48532
Phone (810) 342-4545

Organizations & group practices 3

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.

Hospital & facility affiliations 8

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": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355270400000",
    "number": "1710989546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "G1071 N BALLENGER HWY",
            "address_2": "SUITE 206",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485044453",
            "telephone_number": "810-234-1651",
            "fax_number": "810-257-0694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "G1071 N BALLENGER HWY",
            "address_2": "SUITE 206",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485044453",
            "telephone_number": "810-234-1651",
            "fax_number": "810-257-0694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDDIREDDY",
        "first_name": "RAVIKUMAR",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-11",
        "last_updated": "2012-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301058453",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3054785",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flint, MI

Sources for this page

Verify at the official NPI Registry.