NPIMap

Individual provider Active NPI

Surianarayanan Ambalavanan, MD

  • Otolaryngology Physician
  • Celina, OH
National Provider Identifier
1922061910
Registry record updated Aug 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
35-090880 Issued in OH
Practice address
801 Pro Dr Ste D4
Vanan ENT & Sinus Center
Celina, OH 45822-3307
Phone
(419) 586-6480
Fax
(419) 586-8509
NPI assigned
Apr 10, 2006
Last updated
Aug 5, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 35-090880 OH Primary

Addresses

Primary practice location

801 Pro Dr Ste D4
Vanan ENT & Sinus Center
Celina, OH 45822-3307

Mailing address

200 Saint Clair Ave
JTDM Family Practice LLC
Saint Marys, OH 45885-2400
Phone (419) 394-3387

Other identifiers 3

IdentifierTypeStateIssuer
1184652539OtherOHGROUP NPI
2820755MedicaidOH
9934723OtherOHMEDICARE GROUP PTAN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address surianarayananambalavanan@glhs.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20080327000083 OH Practitioner - Otolaryngology 3971531393 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
JTDM Family Practice LLCGroup PAC ID 2163415837, 48 clinicians

Practice addresses (Care Compare)

801 Pro Dr
Suite D4
Celina, OH 45822-3307
Phone (419) 586-6480

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.44 of 100Reported as group
Quality
78
Promoting interoperability
96
Improvement activities
40
Cost
76.79

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35-090880OHMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
JTDM Family Practice LLC Otolaryngology CurrentSince Jun 2, 2014 Accepting new patients
Orthopaedic Institute of Ohio, Inc. Past Accepting new patients
Ear, Nose, Throat Physicians of Eastern Ky Otolaryngology PastSince Jan 1, 1990 Accepting new patients
Mercy Health-St Ritas Medical Center LLC Otolaryngology Past Accepting new patients
Lima Memorial Joint Operating Company PastSince Jun 2, 2014 Accepting new patients
Joint Township District Memorial Hospital Past Accepting new patients

Locations

801 Pro Dr
Ste D4
Celina, OH 45822
Phone (419) 586-6480

4463 State Route 66
Ste A
Minster, OH 45865
Phone (419) 628-3821

1040 Hager St
Saint Marys, OH 45885
Phone (419) 394-9959

200 Saint Clair Ave
Saint Marys, OH 45885
Phone (419) 394-3387

Interoperability endpoints

  • Direct secure messaging: surianarayananambalavanan@glhs.allscriptsdirect.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596585600000",
    "number": "1922061910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 SAINT CLAIR AVE",
            "address_2": "JTDM FAMILY PRACTICE LLC",
            "city": "SAINT MARYS",
            "state": "OH",
            "postal_code": "458852400",
            "telephone_number": "419-394-3387",
            "fax_number": "419-586-8509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 PRO DR STE D4",
            "address_2": "VANAN ENT & SINUS CENTER",
            "city": "CELINA",
            "state": "OH",
            "postal_code": "458223307",
            "telephone_number": "419-586-6480",
            "fax_number": "419-586-8509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMBALAVANAN",
        "first_name": "SURIANARAYANAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-10",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "OH",
            "license": "35-090880",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1184652539",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2820755",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "9934723",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "surianarayananambalavanan@glhs.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "801 Pro Dr Ste D4",
            "address_2": "Vanan ENT & Sinus Center",
            "city": "Celina",
            "state": "OH",
            "country_code": "US",
            "postal_code": "458223307",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Celina, OH

Sources for this page

Verify at the official NPI Registry.