Individual provider Active NPI

Ganesh Kumar Namachivayam, MD

  • Pediatrics Physician
  • Eau Claire, WI
National Provider Identifier
1902098486
Registry record updated Aug 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
50153-20 Issued in WI
Practice address
733 W Clairemont Ave
Eau Claire, WI 54701-6101
Phone
(715) 838-5222
NPI assigned
Aug 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 24286 NE
Pediatrics Physician 208000000X 50153-20 WI Primary

Addresses

Primary practice location

733 W Clairemont Ave
Eau Claire, WI 54701-6101

Mailing address

200 1St St SW
Rochester, MN 55905-0001
Phone (715) 838-5222

Other identifiers 1

IdentifierTypeStateIssuer
1902098486MedicaidWI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gnamachivayam24281@ehrdirect.mayoclinicmsg.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110825000322 WI Practitioner - Pediatric Medicine 3274627237 Reassigns benefits to 5 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
24286NEMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. Current Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. Current Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. CurrentSince Jan 1, 2017 Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. CurrentSince Jan 1, 2017 Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. Current Accepting new patients

Locations

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

1222 E Woodland Ave
Barron, WI 54812
Phone (715) 537-3166

1501 Thompson St
Bloomer, WI 54724
Phone (715) 568-2000

733 W Clairemont Ave
Eau Claire, WI 54701
Phone (715) 838-3806

1400 Bellinger St
Eau Claire, WI 54703
Phone (715) 838-3311

2409 Stout Rd
Menomonie, WI 54751
Phone (715) 231-3937

331 S Main St
Rice Lake, WI 54868
Phone (715) 236-8500

331 S Main St
Ste H
Rice Lake, WI 54868
Phone (715) 236-8500

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1187308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660003200000",
    "number": "1902098486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050001",
            "telephone_number": "715-838-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "733 W CLAIREMONT AVE",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547016101",
            "telephone_number": "715-838-5222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAMACHIVAYAM",
        "first_name": "GANESH KUMAR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-17",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NE",
            "license": "24286",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "50153-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902098486",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gnamachivayam24281@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "733 W Clairemont Ave",
            "city": "Eau Claire",
            "state": "WI",
            "country_code": "US",
            "postal_code": "547016101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Eau Claire, WI

Sources for this page

Verify at the official NPI Registry.