Individual provider Active NPI

Santhana Sriradchatha, D.O.

  • Emergency Medicine Physician
  • Vineland, NJ
National Provider Identifier
1720433758
Registry record updated Aug 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
83731 Issued in GA
Practice address
1505 W Sherman Ave
Vineland, NJ 08360-7059
Phone
(856) 641-8000
NPI assigned
Apr 27, 2016
Last updated
Aug 13, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 25MB10447800 NJ
Emergency Medicine Physician 207P00000X 83731 GA Primary

Addresses

Primary practice location

1505 W Sherman Ave
Vineland, NJ 08360-7059

Mailing address

1505 W Sherman Ave
Vineland, NJ 08360-7059
Phone (856) 641-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, GA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20181221000066 NJ Practitioner - Emergency Medicine 5294070199 Reassigns benefits to 2 organizations
I20191015000843 GA Practitioner - Emergency Medicine 5294070199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Acs Primary Care Physicians - Southeast PCGroup PAC ID 5193620714, 409 clinicians

Practice addresses (Care Compare)

1900 Tebeau St
Waycross, GA 31501-6357
Phone (912) 283-3030

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
83731GAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hudson Premier Medical PC CurrentSince Sep 12, 2022 Accepting new patients
Acs Primary Care Physicians - Southeast PC Emergency Medicine CurrentSince Sep 1, 2019 Accepting new patients
Stadium Emergency Associates CurrentSince Jul 8, 2023 Accepting new patients
Inspira Health Network Medical Group, P.C. Past Accepting new patients

Locations

2151 W Spring St
Monroe, GA 30655
Phone (770) 267-1792

1900 Tebeau St
Waycross, GA 31501
Phone (912) 283-3030

230 E Ridgewood Ave
Paramus, NJ 07652
Phone (201) 225-4700

55 Meadowlands Pkwy
Secaucus, NJ 07094
Phone (201) 325-6744

66 W Gilbert St
Tinton Falls, NJ 07701
Phone (732) 212-0051

Organizations & group practices 4

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 1

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": "1461715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565654400000",
    "number": "1720433758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 W SHERMAN AVE",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083607059",
            "telephone_number": "856-641-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 W SHERMAN AVE",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083607059",
            "telephone_number": "856-641-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SRIRADCHATHA",
        "first_name": "SANTHANA",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-27",
        "last_updated": "2019-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NJ",
            "license": "25MB10447800",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "83731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vineland, NJ

Sources for this page

Verify at the official NPI Registry.