Active NPI
Revathi Reena Ramani, MD
- Pediatrics Physician
- Fort Wayne, IN
National Provider Identifier
1851442891
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 1058613A
- Practice address
- 2622 Lake Ave
Fort Wayne, IN 46805-5410 - Phone
- (260) 425-3752
- Fax
- (260) 745-1321
- NPI assigned
- Jan 16, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 1058613A | IN | Primary |
Addresses
Primary practice location
2622 Lake Ave
Fort Wayne, IN 46805-5410
Mailing address
2622 Lake Ave
Fort Wayne, IN 46805-5410
Phone (260) 425-3752
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200852640 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 1, 2021 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1058613A | IN | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426204800000",
"number": "1851442891",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2622 LAKE AVE",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468055410",
"telephone_number": "260-425-3752",
"fax_number": "260-745-1321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2622 LAKE AVE",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468055410",
"telephone_number": "260-425-3752",
"fax_number": "260-745-1321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAMANI",
"first_name": "REVATHI",
"middle_name": "REENA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-16",
"last_updated": "2015-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IN",
"license": "1058613A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200852640",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2015; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.