NPIMap

Individual provider Active NPI

Srimannarayana Marella, M.D

  • Family Medicine Physician
  • Edwardsville, IL
National Provider Identifier
1861745218
Registry record updated Sep 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2013018498 Issued in MO
Practice address
3417 Anderson Healthcare Dr Ste 200
Edwardsville, IL 62025-7784
Phone
(618) 288-8500
Fax
(618) 288-8501
NPI assigned
Oct 23, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2013018498 MO Primary

Addresses

Primary practice location

3417 Anderson Healthcare Dr Ste 200
Edwardsville, IL 62025-7784

Mailing address

6810 State Route 162 Box 215
Maryville, IL 62062-8501
Phone (618) 391-6405

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20170511001222 IL Practitioner - Family Practice 1951535129 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anderson Medical Group LLCGroup PAC ID 5193792018, 136 clinicians
Aging Well Health Care, LLCGroup PAC ID 1153232038, 236 clinicians

Practice addresses (Care Compare)

3403 Anderson Healthcare Dr
Edwardsville, IL 62025-7784
Phone (618) 288-8350

3417 Anderson Healthcare Dr
Suite 200
Edwardsville, IL 62025-7784
Phone (618) 288-8500

7212 Balson Ave
Saint Louis, MO 63130-3001

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
74.76 of 100Reported as group
Quality
54.98
Promoting interoperability
85
Improvement activities
40
Cost
73.39

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Anderson Medical Group, LLC Family Medicine CurrentSince Jun 15, 2017 Accepting new patients
Malench & Malench MDS Family Medicine PastSince Mar 1, 2020 Accepting new patients
Central Illinois Radiological Associates, LTD. PastSince Sep 15, 2024 Accepting new patients

Locations

6616 Center Grove Rd
Edwardsville, IL 62025
Phone (618) 659-1599

3417 Anderson Healthcare Dr
Ste 200
Edwardsville, IL 62025
Phone (618) 288-8500

3417 Anderson Healthcare Dr
Edwardsville, IL 62025
Phone (618) 288-8490

10 Professional Park Dr
Maryville, IL 62062
Phone (618) 288-7244

6810 State Route 162
Ste 215
Maryville, IL 62062
Phone (618) 391-6405

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1350950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1861745218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6810 STATE ROUTE 162 BOX 215",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628501",
            "telephone_number": "618-391-6405",
            "fax_number": "618-288-4088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3417 ANDERSON HEALTHCARE DR STE 200",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620257784",
            "telephone_number": "618-288-8500",
            "fax_number": "618-288-8501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARELLA",
        "first_name": "SRIMANNARAYANA",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-23",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2013018498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edwardsville, IL

Sources for this page

Verify at the official NPI Registry.