NPIMap

Individual provider Active NPI

Venkata R. Reddivari, M.D.

  • Nephrology Physician
  • Tampa, FL
National Provider Identifier
1861685844
Registry record updated Apr 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
ME116695 Issued in FL
Practice address
2810 W Saint Isabel St
Suite 101
Tampa, FL 33607-6375
Phone
(813) 873-7479
NPI assigned
Aug 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X ME116695 FL Primary

Addresses

Primary practice location

2810 W Saint Isabel St
Suite 101
Tampa, FL 33607-6375

Mailing address

PO Box 14657
Clearwater, FL 33766-4657
Phone (727) 797-6768

Other identifiers 1

IdentifierTypeStateIssuer
009448300MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131010001490 FL Practitioner - NephrologyPractitioner - Internal Medicine 9032291042 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Karon R Locicero MD PAGroup PAC ID 3678593357, 18 clinicians
National Kidney Partners LLPGroup PAC ID 7012981350, 63 clinicians

Practice addresses (Care Compare)

110 S Macdill Ave
300 Locicero Medical Group
Tampa, FL 33609-4044
Phone (813) 876-7073

508 Manatee Ave E
Bradenton, FL 34208-1146
Phone (941) 744-0024

Hospital & facility affiliations

  • DaVita Central Tampa Dialysis Dialysis facility, Tampa, FL, CCN 102605
  • DaVita Carrollwood Dialysis Dialysis facility, Tampa, FL, CCN 682520
  • Carrollwood Artificial Kidney Center Dialysis facility, Tampa, FL, CCN 102681
  • DaVita Del Rio Dialysis Dialysis facility, Tampa, FL, CCN 682683
  • St Josephs Hospital Hospital, Tampa, FL, CCN 100075
  • Adventhealth Tampa Hospital, Tampa, FL, CCN 100173
  • Tampa General Hospital Hospital, Tampa, FL, CCN 100128
  • AdventHealth Carrollwood Hospital, Tampa, FL, CCN 100069
  • HCA Florida Brandon Hospital Hospital, Brandon, FL, CCN 100243

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: vreddivari77185@direct.acumenmd.com

Organizations & group practices 2

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.

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1187740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428969600000",
    "number": "1861685844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14657",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337664657",
            "telephone_number": "727-797-6768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 W SAINT ISABEL ST",
            "address_2": "SUITE 101",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336076375",
            "telephone_number": "813-873-7479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDDIVARI",
        "first_name": "VENKATA",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-22",
        "last_updated": "2015-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME116695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009448300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.