Active NPI
Balakrishnan Sridharan, MD
- Internal Medicine Physician
- Charleston, WV
National Provider Identifier
1881685550
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 19265
- Practice address
- 3200 Maccorkle Ave SE
Hospitalists Program
Charleston, WV 25304-1227 - Phone
- (304) 388-5848
- Fax
- (304) 388-9654
- NPI assigned
- Nov 2, 2005
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 19265 | WV | Primary |
| Hospitalist Physician | 208M00000X | 19265 | WV |
Addresses
Primary practice location
3200 Maccorkle Ave SE
Hospitalists Program
Charleston, WV 25304-1227
Mailing address
415 Morris St
Suite 304
Charleston, WV 25301-1842
Phone (304) 388-7782
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1809060000 | Medicaid | WV | |
| P00824219 | Other | WV | RAILROAD MEDICARE |
| 3810016539 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13748 | AZ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hospital Physician Services of Florida PA | Internal Medicine | Current | Accepting new patients |
| Hospitalist Medicine Physicians of Charleston, PLLC | Internal Medicine | Past | Accepting new patients |
| Charleston Area Medical Center Inc | Past | Accepting new patients |
Locations
8383 N Davis Hwy
Pensacola, FL 32514
Phone (850) 494-3212
200 Avenue F NE
Winter Haven, FL 33881
Phone (863) 292-4652
Organizations & group practices 3
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.
-
- Hospitalist Physician
- Pensacola, FL
- NPI 1558718635
Internal Medicine
-
- Internal Medicine Physician
- Charleston, WV
- NPI 1760535702
-
- Multi-Specialty Clinic/Center
- Belpre, OH
- NPI 1588422547
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1361923200000",
"number": "1881685550",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 MORRIS ST",
"address_2": "SUITE 304",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253011842",
"telephone_number": "304-388-7782",
"fax_number": "304-388-7788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 MACCORKLE AVE SE",
"address_2": "HOSPITALISTS PROGRAM",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253041227",
"telephone_number": "304-388-5848",
"fax_number": "304-388-9654"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SRIDHARAN",
"first_name": "BALAKRISHNAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-02",
"last_updated": "2013-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "WV",
"license": "19265",
"primary": true
},
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "WV",
"license": "19265",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1809060000",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00824219",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3810016539",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2013; 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.