Raj Kandavanam, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME111840 Issued in FL

Practice address

1590 S Sr 15a
Suite 100
Deland, FL 32720-7817

Phone

(386) 774-0016

Fax

(386) 774-0606

NPI assigned

May 26, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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 1

Specialty

Family Practice

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Ability Health Services, IncGroup PAC ID 4082523329, 1,249 clinicians

Ability Health Services and Rehabilitation LPGroup PAC ID 4981986288, shared by 2 NPIs, 1,260 clinicians

Ormond Medical ArtsGroup PAC ID 1254222565, 38 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Centerwell Home Health Home health agency, Daytona Beach, FL, CCN 107338
• Adventhealth Deland Hospital, Deland, FL, CCN 100045
• Adventhealth Fish Memorial Hospital, Orange City, FL, CCN 100072

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: raj.kandavanam.1@15135.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/1579/brand/8/csg/141/fhir/r4

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.

• Ormond Medical Arts Family Practice LLC

  • Family Medicine Physician
  • Ormond Beach, FL
  • NPI 1326254962
  Medicare reassignment Care Compare group NPD
• Openloop Healthcare Partners PC

  • General Practice Physician
  • Des Moines, IA
  • NPI 1245820661

  FL

  Medicare reassignment NPD (past)
• DRH Medical Group

  • Urgent Care Clinic/Center
  • Oakland, CA
  • NPI 1790560225
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Centerwell Health Services (Certified), Inc.

  • Home Health Agency
  • Daytona Beach, FL
  • NPI 1114955713
  Care Compare affiliation Name & address match
• Memorial Hospital-West Volusia Inc

  • General Acute Care Hospital
  • Deland, FL
  • NPI 1649367269
  Care Compare affiliation
• Southwest Volusia Healthcare Corporation

  • General Acute Care Hospital
  • Orange City, FL
  • NPI 1700978558
  Care Compare affiliation
• Southwest Volusia Healthcare Corporation

  • Internal Medicine Physician
  • Orange City, FL
  • NPI 1902095078

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1243296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367366400000",
    "number": "1821223587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1590 S SR 15A",
            "address_2": "SUITE 100",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327207817",
            "telephone_number": "386-774-0016",
            "fax_number": "386-774-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1590 S SR 15A",
            "address_2": "SUITE 100",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327207817",
            "telephone_number": "386-774-0016",
            "fax_number": "386-774-0606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANDAVANAM",
        "first_name": "RAJ",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-26",
        "last_updated": "2013-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME111840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taneesha Susanne Juras, DC
• Elizabeth L Jurenko
• Gizem Kahveci, DO
• Frederick Hayward Kaiser, RPH
• Mekhiel Kamel
• Musue Kaneh, FNP
• Erikson Karacheban
• Joseph Yong Kasten
• Katharine Usher, Inc.
• Tanvi Kaushik

• Family Medicine Physician in Deland, FL
• Providers in Deland, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.