Individual provider Active NPI

Mahesh Anil Netravali, M.D.

  • Allergy & Immunology Physician
  • Waterford, CT
National Provider Identifier
1942424551
Registry record updated Apr 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
048463 Issued in CT
Practice address
196 Waterford Pkwy S Ste 305B
Waterford, CT 06385-1245
Phone
(860) 536-2995
Fax
(860) 574-9170
NPI assigned
Apr 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X 048463 CT Primary

Addresses

Primary practice location

196 Waterford Pkwy S Ste 305B
Waterford, CT 06385-1245

Mailing address

196 Waterford Pkwy S Ste 305B
Waterford, CT 06385-1245
Phone (860) 536-2995

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20100707000392 CT Practitioner - Allergy/Immunology 6103923958 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Allergy/Immunology
Education
State University of New York at Stony Brook, School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shoreline Allergy and Asthma Associates LLPGroup PAC ID 9739157819, 3 clinicians

Practice addresses (Care Compare)

196 Waterford Pkwy S
Suite 305B
Waterford, CT 06385-1245
Phone (860) 536-2995

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
048463CTMDAllergy & Immunology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Shoreline Allergy & Asthma Associates LLP CurrentSince Jul 1, 2010 Accepting new patients

Locations

23 Clara Dr
Ste 204
Mystic, CT 06355
Phone (860) 536-2995

196 Waterford Parkway S
Ste 305B
Waterford, CT 06385
Phone (860) 536-2995

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.71115

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649635200000",
    "number": "1942424551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "196 WATERFORD PKWY S STE 305B",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063851245",
            "telephone_number": "860-536-2995",
            "fax_number": "860-574-9170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "196 WATERFORD PKWY S STE 305B",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063851245",
            "telephone_number": "860-536-2995",
            "fax_number": "860-574-9170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NETRAVALI",
        "first_name": "MAHESH",
        "middle_name": "ANIL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-13",
        "last_updated": "2022-04-11",
        "certification_date": "2022-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "CT",
            "license": "048463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, CT

Sources for this page

Verify at the official NPI Registry.