Active NPI
Ravi Chandra Devabhakthuni, PA-C
- Physician Assistant
- Fairmont, WV
National Provider Identifier
1821549833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2784
- Practice address
- 1322 Locust Ave
Fairmont, WV 26554-1436 - Phone
- (304) 366-0700
- Fax
- (307) 367-8766
- NPI assigned
- Oct 14, 2016
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2784 | WV | Primary |
Addresses
Primary practice location
1322 Locust Ave
Fairmont, WV 26554-1436
Mailing address
1322 Locust Ave
Fairmont, WV 26554-1436
Phone (304) 366-0700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200123001173 | WV | Order and Referring Only - Physician Assistant | 8729184528 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2017 | WV | MD | General Practice Dentistry |
| 2784 | WV | MD | Physical Therapy Assistant |
Interoperability endpoints
- ravi.devabhakthuni@mvahealth.directbygreenway.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476403200000",
"number": "1821549833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1322 LOCUST AVE",
"city": "FAIRMONT",
"state": "WV",
"postal_code": "265541436",
"telephone_number": "304-366-0700",
"fax_number": "307-367-8766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1322 LOCUST AVE",
"city": "FAIRMONT",
"state": "WV",
"postal_code": "265541436",
"telephone_number": "304-366-0700",
"fax_number": "307-367-8766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEVABHAKTHUNI",
"first_name": "RAVI",
"middle_name": "CHANDRA",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-10-14",
"last_updated": "2016-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WV",
"license": "2784",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairmont, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2016; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.