NPIMap

Individual provider Active NPI

Shanthi Dhaduvai, MD

  • Rheumatology Physician
  • Roanoke, VA
National Provider Identifier
1740448695
Registry record updated Nov 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
0101-253490 Issued in VA
Practice address
3 Riverside Cir
Carilion Clinic
Roanoke, VA 24016-4955
Phone
(540) 224-5170
Fax
(540) 526-1099
NPI assigned
May 28, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Rheumatology Physician 207RR0500X 0101-253490 VA Primary

Addresses

Primary practice location

3 Riverside Cir
Carilion Clinic
Roanoke, VA 24016-4955

Mailing address

3 Riverside Cir
Carilion Clinic
Roanoke, VA 24016-4955
Phone (540) 224-5170

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20200729002160 FL Practitioner - Rheumatology 4082858774 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Rheumatology
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Vincent's Ambulatory Care IncGroup PAC ID 2860411188, 303 clinicians

Practice addresses (Care Compare)

3 Shircliff Way
Suite 333
Jacksonville, FL 32204-4790
Phone (904) 296-5870

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101-253490VAMDRheumatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincents Ambulatory Care Inc CurrentSince Feb 1, 2022 Accepting new patients
Omni Healthcare, Inc. Rheumatology CurrentSince Aug 1, 2020 Accepting new patients
St Vincents Ambulatory Care Inc CurrentSince Feb 1, 2022 Accepting new patients

Locations

3 Shircliff Way
Ste 714
Jacksonville, FL 32204
Phone (904) 305-1350

3 Shircliff Way
Ste 333
Jacksonville, FL 32204
Phone (904) 296-5870

4203 Belfort Rd
Ste 215
Jacksonville, FL 32216
Phone (904) 296-4141

95 Bulldog Blvd
Ste 202
Melbourne, FL 32901
Phone (321) 676-1870

1344 S Apollo Blvd
Ste 300
Melbourne, FL 32901
Phone (321) 308-0659

1344 S Apollo Blvd
Ste 406
Melbourne, FL 32901
Phone (321) 253-4032

Interoperability endpoints

  • Direct secure messaging: shanthi.dhaduvai.1@8967.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1211932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415836800000",
    "number": "1740448695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 RIVERSIDE CIR",
            "address_2": "CARILION CLINIC",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240164955",
            "telephone_number": "540-224-5170",
            "fax_number": "540-526-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 RIVERSIDE CIR",
            "address_2": "CARILION CLINIC",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240164955",
            "telephone_number": "540-224-5170",
            "fax_number": "540-526-1099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DHADUVAI",
        "first_name": "SHANTHI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-28",
        "last_updated": "2014-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "VA",
            "license": "0101-253490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.