Shankar Keralapura Sridhara, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

0101245003 Issued in VA

Practice address

300 Hospital Road
Eent Clinic
Fort Gordon, GA 30905-5650

Phone

(706) 787-7822

Fax

(706) 787-2666

NPI assigned

Jul 14, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in DC

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

Specialty

Otolaryngology

Education

Boston University School of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kaiser Foundation Health Plan of the Mid Atlantic States, IncGroup PAC ID 3779495858, 1,921 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • Health Maintenance Organization
  • Annapolis, MD
  • NPI 1952461816

  DC

  Medicare reassignment Care Compare group NPD
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Rockville, MD
  • NPI 1962108753
  NPD

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

{
    "created_epoch": "1184371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622592000000",
    "number": "1932308467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 HOSPITAL ROAD",
            "address_2": "EENT CLINIC",
            "city": "FORT GORDON",
            "state": "GA",
            "postal_code": "309055650",
            "telephone_number": "706-787-7822",
            "fax_number": "706-787-2666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 HOSPITAL ROAD",
            "address_2": "EENT CLINIC",
            "city": "FORT GORDON",
            "state": "GA",
            "postal_code": "309055650",
            "telephone_number": "706-787-7822",
            "fax_number": "706-787-2666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SRIDHARA",
        "first_name": "SHANKAR",
        "middle_name": "KERALAPURA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-14",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "VA",
            "license": "0101245003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "8008 Westpark Dr",
            "city": "Mc Lean",
            "state": "VA",
            "country_code": "US",
            "postal_code": "221023109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jae Yun Song, DMD
• Margaret R. Souers, LCSW
• Joshua Thomas Sparks, D.M.D.
• Vicky Lynn Spite
• Andrew Joseph Sprader, DO
• Jonathan Stabile, DO, MPH
• Nicholas Everette Stancil, DO
• Carl S. Steinberg, D.O.
• Jack Stephenson
• Michael Joel Stewart, D.M.D.

• Otolaryngology Physician in Fort Gordon, GA
• Providers in Fort Gordon, GA by specialty
• Otolaryngology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.