Suganthi Ravindran Physician P.C

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SUGANTHI RAVINDRAN PHYSICIAN P.C

Practice address

709 Hawkins Ave Ste 1
Lake Ronkonkoma, NY 11779-2293

Phone

(631) 588-0880

Fax

(631) 588-0391

NPI assigned

May 30, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Suganthi Ravindran, MDNPI 1578659819

Title

President

Phone

(631) 588-0880

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Suganthi Ravindran, MD

  • Internal Medicine Physician
  • Ronkonkoma, NY
  • NPI 1578659819
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1559174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559174400000",
    "number": "1912565490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 HAWKINS AVE STE 1",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117792293",
            "telephone_number": "631-588-0880",
            "fax_number": "631-588-0391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 HAWKINS AVE STE 1",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117792293",
            "telephone_number": "631-588-0880",
            "fax_number": "631-588-0391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUGANTHI RAVINDRAN PHYSICIAN P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-30",
        "last_updated": "2019-05-30",
        "status": "A",
        "authorized_official_last_name": "RAVINDRAN",
        "authorized_official_first_name": "SUGANTHI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-588-0880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIP MEDICAID",
            "identifier": "199922",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen Smith, RN
• Tracey Lynn Smith, PT
• Francine V Sohl, REGISTERED NURSE
• Jennifer Shannon Stachel, DMD
• Stop and Shop Supermarket Co LLC
• Justin Michael Taylor I, LICENSED MSW
• Theodore Fried Burford Welch & David Hauer MD, PC
• Keyana Maria Thomas
• Sara Diane Tolson, TSSLD
• Robert Andrew Tufano, D.O.

• Internal Medicine Physician in Lake Ronkonkoma, NY
• Providers in Lake Ronkonkoma, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.