NPIMap

Individual provider Active NPI

Srivilliputtur Gopalan Santhana Krishnan, M.D

  • Nephrology Physician
  • Grand Rapids, MI
National Provider Identifier
1902850316
Registry record updated Jan 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
4301093886 Issued in MI
Practice address
330 E Beltline Ave NE
Suite 100
Grand Rapids, MI 49506-1267
Phone
(616) 752-6235
Fax
(616) 328-8177
NPI assigned
May 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2020

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 4301093886 MI Primary

Addresses

Primary practice location

330 E Beltline Ave NE
Suite 100
Grand Rapids, MI 49506-1267

Mailing address

330 E Beltline Ave NE
Suite 100
Grand Rapids, MI 49506-1267
Phone (616) 752-6235

Other identifiers 1

IdentifierTypeStateIssuer
1902850316MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20090611000490 MI Practitioner - Nephrology 0648275230 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Renal Associates of West Michigan PCGroup PAC ID 2466348644, 20 clinicians

Practice addresses (Care Compare)

330 E Beltline Ave NE
Suite 100
Grand Rapids, MI 49506-1267
Phone (616) 752-6235

Hospital & facility affiliations

  • FMC Hastings Ave - Holland Dialysis facility, Holland, MI, CCN 232640
  • FMC Royal Park - Zeeland Dialysis facility, Zeeland, MI, CCN 232564
  • DaVita Beltline Home Training Dialysis facility, Grand Rapids, MI, CCN 232693
  • Spectrum Health Hospital, Grand Rapids, MI, CCN 230038
  • Mercy Health Saint Mary'S Hospital, Grand Rapids, MI, CCN 230059
  • University of Michigan Health - West Hospital, Wyoming, MI, CCN 230236
  • Holland Hospital Hospital, Holland, MI, CCN 230072
  • Spectrum Health United Hospital Hospital, Greenville, MI, CCN 230035
  • Mary Free Bed Rehabilitation Hospital Inpatient rehabilitation facility, Grand Rapids, MI, CCN 233026

Merit-based Incentive Payment System (MIPS)

Final score
12.28 of 100Reported as individual
Quality
0
Promoting interoperability
0
Improvement activities
0
Cost
40.93

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301093886MIMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Renal Associates of West Michigan PC Nephrology CurrentSince Jul 1, 2009 Accepting new patients
Rai Care Centers of Holland, LLC Past Accepting new patients

Locations

330 E Beltline Ave NE
Ste 100
Grand Rapids, MI 49506
Phone (616) 752-6235

649 Hastings Ave
Holland, MI 49423
Phone (616) 392-3263

Interoperability endpoints

  • Direct secure messaging: ssanthanakrishnan35981@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": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579219200000",
    "number": "1902850316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 E BELTLINE AVE NE",
            "address_2": "SUITE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495061267",
            "telephone_number": "616-752-6235",
            "fax_number": "616-328-8177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 E BELTLINE AVE NE",
            "address_2": "SUITE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495061267",
            "telephone_number": "616-752-6235",
            "fax_number": "616-328-8177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTHANA KRISHNAN",
        "first_name": "SRIVILLIPUTTUR",
        "middle_name": "GOPALAN",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2020-01-17",
        "certification_date": "2020-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MI",
            "license": "4301093886",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902850316",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.