NPIMap

Individual provider Active NPI

Supriya Ravella, M.D

  • Nephrology Physician
  • Rahway, NJ
National Provider Identifier
1801165873
Registry record updated Jun 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
25MA09174800 Issued in NJ
Practice address
546 Saint Georges Ave
Rahway, NJ 07065-2542
Phone
(732) 381-3642
Fax
(732) 396-4463
NPI assigned
Dec 21, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 16, 2021

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
Nephrology Physician 207RN0300X 25MA09174800 NJ Primary

Addresses

Primary practice location

546 Saint Georges Ave
Rahway, NJ 07065-2542

Mailing address

51 Puchala Dr
Parlin, NJ 08859-2198
Phone (732) 690-3298

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20150505000096 NJ Practitioner - Internal MedicinePractitioner - Nephrology 0840519385 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Nephrology
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Institute for Hypertension and Kidney Diseases, P.C.Group PAC ID 8820189129, 7 clinicians

Practice addresses (Care Compare)

546 Saint Georges Ave
Rahway, NJ 07065-2542
Phone (732) 381-3642

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Institute for Hypertension and Kidney Diseases PC Nephrology CurrentSince Apr 1, 2016 Accepting new patients
Associates in Kidney Disease & Hypertension LLC Nephrology CurrentSince Sep 1, 2015 Accepting new patients
HMH Hospitals Corporation Past Accepting new patients
Trinitas Regional Medical Center Past Accepting new patients

Locations

65 James St
Edison, NJ 08820
Phone (732) 321-7010

2177 Oak Tree Rd
Ste 204
Edison, NJ 08820
Phone (908) 686-9330

240 Williamson St
Ste 206
Elizabeth, NJ 07202
Phone (908) 353-6668

225 Williamson St
Elizabeth, NJ 07202
Phone (908) 994-5204

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 and National Provider Directory roles.

Hospital & facility affiliations 10

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": "1324425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623801600000",
    "number": "1801165873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 PUCHALA DR",
            "city": "PARLIN",
            "state": "NJ",
            "postal_code": "088592198",
            "telephone_number": "732-690-3298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "546 SAINT GEORGES AVE",
            "city": "RAHWAY",
            "state": "NJ",
            "postal_code": "070652542",
            "telephone_number": "732-381-3642",
            "fax_number": "732-396-4463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAVELLA",
        "first_name": "SUPRIYA",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-12-21",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NJ",
            "license": "25MA09174800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rahway, NJ

Sources for this page

Verify at the official NPI Registry.