NPIMap

Organization Active NPI

Riverside Primary Care Associates LLC

  • Internal Medicine Physician
  • District Heights, MD
National Provider Identifier
1962456962
Registry record updated Mar 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
RIVERSIDE PRIMARY CARE ASSOCIATES LLC
Practice address
6400 Marlboro Pike
District Heights, MD 20747-2841
Phone
(301) 736-7000
Fax
(301) 736-6916
NPI assigned
May 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2015

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

Authorized official

Name
Madhu Mohan Katikineni, M.D.
Title
President
Phone
(301) 927-7750

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X

Addresses

Primary practice location

6400 Marlboro Pike
District Heights, MD 20747-2841

Mailing address

6510 Kenilworth Ave
Suite 1400
Riverdale, MD 20737-1339
Phone (301) 927-2683

Other identifiers 1

IdentifierTypeStateIssuer
749501310MedicaidMD

National Provider Directory

National Provider Directory

Locations

2191 Defense Hwy
Ste 201
Crofton, MD 21114
Phone (410) 451-9091

6510 Kenilworth Ave
Ste 1400
Riverdale, MD 20737
Phone (301) 779-0095

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425513600000",
    "number": "1962456962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6510 KENILWORTH AVE",
            "address_2": "SUITE 1400",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371339",
            "telephone_number": "301-927-2683",
            "fax_number": "301-779-8243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6400 MARLBORO PIKE",
            "city": "DISTRICT HEIGHTS",
            "state": "MD",
            "postal_code": "207472841",
            "telephone_number": "301-736-7000",
            "fax_number": "301-736-6916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE PRIMARY CARE ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2015-03-05",
        "status": "A",
        "authorized_official_last_name": "KATIKINENI",
        "authorized_official_first_name": "MADHU",
        "authorized_official_middle_name": "MOHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-927-7750",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "749501310",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in District Heights, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.