Active NPI
Sangeetha Raghavendra, DMD
- Prosthodontics
- Chicopee, MA
National Provider Identifier
1871614883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 21113
- Practice address
- 391 Montgomery St
Chicopee, MA 01020-1929 - Phone
- (413) 592-8099
- Fax
- (413) 592-5839
- NPI assigned
- Apr 3, 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 |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 21113 | MA | Primary |
Addresses
Primary practice location
391 Montgomery St
Chicopee, MA 01020-1929
Mailing address
391 Montgomery St
Chicopee, MA 01020-1929
Phone (413) 592-8099
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1426492 | Other | CA | UNITED CONCORDIA |
| X11395 | Other | MA | BCBS MA |
| 1426492 | Other | CA | TRICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21113 | MA | MD | Prosthodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wegrzyn Dental Group Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Chicopee, MA
- NPI 1487788204
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1871614883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "391 MONTGOMERY ST",
"city": "CHICOPEE",
"state": "MA",
"postal_code": "010201929",
"telephone_number": "413-592-8099",
"fax_number": "413-592-5839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "391 MONTGOMERY ST",
"city": "CHICOPEE",
"state": "MA",
"postal_code": "010201929",
"telephone_number": "413-592-8099",
"fax_number": "413-592-5839"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAGHAVENDRA",
"first_name": "SANGEETHA",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "MA",
"license": "21113",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "1426492",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MA",
"identifier": "X11395",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "1426492",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicopee, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.