Individual provider Active NPI

Ravi Kumar Raju Gadiraju

  • Hospitalist Physician
  • Charlotte, NC
National Provider Identifier
1912924911
Registry record updated Jun 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
2007-01018 Issued in NC
Practice address
200 Hawthorne LN
Charlotte, NC 28204-2515
Phone
(704) 384-5416
Fax
(704) 384-5992
NPI assigned
Jul 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 2007-01018 NC Primary
Internal Medicine Physician 207R00000X 2007-01018 NC
Internal Medicine Physician 207R00000X 01062363A IN

Addresses

Primary practice location

200 Hawthorne LN
Charlotte, NC 28204-2515

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-5416

Other identifiers 3

IdentifierTypeStateIssuer
200840670MedicaidIN
5907666MedicaidNC
N0101DMedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rgadiraju325723@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20070920000325 NC Practitioner - HospitalistPractitioner - Internal Medicine 8527162759 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

200 Hawthorne LN
Charlotte, NC 28204-2515
Phone (704) 384-5416

Hospital & facility affiliations

  • Novant Health Presbyterian Medical Center Hospital, Charlotte, NC, CCN 340053

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01062363AINMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Sep 1, 2016 Accepting new patients
Novant Health Medical Group, LLC Internal Medicine CurrentSince Sep 1, 2016 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Wabash Valley Hospitalists LLC Internal Medicine Past Accepting new patients

Locations

200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424

1901 Randolph Rd
Charlotte, NC 28207
Phone (704) 316-2000

990 Lee Ann Dr NE
Concord, NC 28025
Phone (704) 441-0272

612 Mocksville Ave
Salisbury, NC 28144
Phone (704) 210-5000

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: rgadiraju325723@direct.novanthealth.org

Organizations & group practices 4

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 4

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": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686700800000",
    "number": "1912924911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-384-5416",
            "fax_number": "704-384-5992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HAWTHORNE LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042515",
            "telephone_number": "704-384-5416",
            "fax_number": "704-384-5992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GADIRAJU",
        "first_name": "RAVI",
        "middle_name": "KUMAR RAJU",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-16",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NC",
            "license": "2007-01018",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2007-01018",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01062363A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200840670",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5907666",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N0101D",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rgadiraju325723@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "200 Hawthorne Ln",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282042515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.