Jagannathan Srinivasaraghavan, M.D.

Primary specialty

Forensic Psychiatry PhysicianTaxonomy code 2084F0202X

License

36-057049 Issued in IL

Practice address

247 Lake Indian Hills Dr
Carbondale, IL 62902-6184

Phone

(618) 351-9989

NPI assigned

Dec 30, 2008

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1230595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1230595200000",
    "number": "1821234501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "247 LAKE INDIAN HILLS DR",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629026184",
            "telephone_number": "618-351-9989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "247 LAKE INDIAN HILLS DR",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629026184",
            "telephone_number": "618-351-9989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SRINIVASARAGHAVAN",
        "first_name": "JAGANNATHAN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-12-30",
        "last_updated": "2008-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084F0202X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Forensic Psychiatry",
            "state": "IL",
            "license": "36-057049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Elayne Sparks, MA, LCPC
• Pamela Kay Sparling, CRNA
• Speech & Language Development Center
• Ryan C Speelman
• Robert Michael Sprague, DO
• Shreya Sriram
• St. Louis JC Vamc
• Mike Staff, PA
• Darrell Stamper, BA
• Michael Stanley, DO, MS

• Forensic Psychiatry Physician in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Forensic Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.