Active NPI
Kathariguppa Subbaramaiah Venkataram, MD
- Internal Medicine Physician
- Tampa, FL
National Provider Identifier
1811926488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- ME73717
- Practice address
- 5130 Sunforest Dr Ste 300
Tampa, FL 33634-6327 - Phone
- (727) 824-0780
- Fax
- (813) 514-8891
- NPI assigned
- Jul 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | ME73717 | FL | Primary |
Addresses
Primary practice location
5130 Sunforest Dr Ste 300
Tampa, FL 33634-6327
Mailing address
5130 Sunforest Dr Ste 300
Tampa, FL 33634-6327
Phone (727) 824-0780
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 44245 | Other | FL | BLUE CROSS BLUE SHIELD |
| 284819 | Other | FL | AVMED |
| 260523600 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME73717 | FL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optumcare Florida Ci, LLC | Past | Accepting new patients |
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Organizations & group practices 1
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.
-
- Primary Care Clinic/Center
- Winter Park, FL
- NPI 1720506603
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637625600000",
"number": "1811926488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5130 SUNFOREST DR STE 300",
"city": "TAMPA",
"state": "FL",
"postal_code": "336346327",
"telephone_number": "727-824-0780",
"fax_number": "813-514-8891"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5130 SUNFOREST DR STE 300",
"city": "TAMPA",
"state": "FL",
"postal_code": "336346327",
"telephone_number": "727-824-0780",
"fax_number": "813-514-8891"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VENKATARAM",
"first_name": "KATHARIGUPPA",
"middle_name": "SUBBARAMAIAH",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-03",
"last_updated": "2021-11-23",
"certification_date": "2021-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "FL",
"license": "ME73717",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "44245",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AVMED",
"identifier": "284819",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "260523600",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.