NPIMap

Individual provider Active NPI

Surender R Neravetla, MD

  • Vascular Surgery Physician
  • Springfield, OH
National Provider Identifier
1801843602
Registry record updated Feb 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
045946 Issued in OH
Practice address
1671 N Limestone St
Springfield, OH 45503-2646
Phone
(937) 324-5511
Fax
(937) 398-0652
NPI assigned
May 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 045946 OH Primary

Addresses

Primary practice location

1671 N Limestone St
Springfield, OH 45503-2646

Mailing address

1671 N Limestone St
Springfield, OH 45503-2646
Phone (937) 324-5511

Other identifiers 1

IdentifierTypeStateIssuer
0512181MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20060706000003 OH Practitioner - Thoracic SurgeryPractitioner - Vascular Surgery 0749185387 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Thoracic SurgeryAlso: Vascular Surgery
Education
Other, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Genesis Medical Group, LLCGroup PAC ID 7719040385, 265 clinicians

Practice addresses (Care Compare)

955 Bethesda Dr
FL 1
Zanesville, OH 43701-1873
Phone (740) 454-0804

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)18

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
045946OHMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Medical Group LLC CurrentSince Jun 13, 2024 Accepting new patients
Kettering Independent Medical Group Inc CurrentSince Dec 29, 2022 Accepting new patients
Genesis Medical Group, LLC CurrentSince Jun 13, 2024 Accepting new patients
Springfield Heart Surgeons LLC Vascular Surgery CurrentSince Jul 1, 2006 Accepting new patients
Hans Zwart, M.D. and Associates, Inc Past Accepting new patients
Genesis Healthcare System Past Accepting new patients
Premier Health Specialists Inc Past Accepting new patients

Locations

L2975
Columbus, OH 43260

425 W Grand Ave
Ste 3003
Dayton, OH 45405
Phone (937) 226-7890

4403 Far Hills Ave
Kettering, OH 45429
Phone (937) 395-3910

1671 N Limestone St
Springfield, OH 45503
Phone (937) 324-5511

955 Bethesda Dr
Fl 1
Zanesville, OH 43701
Phone (740) 454-0804

945 Bethesda Dr
Ste 200
Zanesville, OH 43701
Phone (740) 454-4788

945 Bethesda Dr
Ste 330
Zanesville, OH 43701
Phone (740) 454-4038

Interoperability endpoints

  • Direct secure messaging: sneravetla186979@direct.ketteringhealth.org

Organizations & group practices 7

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 4

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": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486512000000",
    "number": "1801843602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1671 N LIMESTONE ST",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455032646",
            "telephone_number": "937-324-5511",
            "fax_number": "937-398-0652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1671 N LIMESTONE ST",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455032646",
            "telephone_number": "937-324-5511",
            "fax_number": "937-398-0652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NERAVETLA",
        "first_name": "SURENDER",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-27",
        "last_updated": "2017-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "OH",
            "license": "045946",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0512181",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, OH

Sources for this page

Verify at the official NPI Registry.