Individual provider Active NPI

Nagesh Gollahalli Shivaramaiah, M.D.

  • Hospitalist Physician
  • Newport News, VA
National Provider Identifier
1962715425
Registry record updated Dec 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
0101260450 Issued in VA
Practice address
500 J Clyde Morris Blvd
Newport News, VA 23601-1929
Phone
(757) 594-3580
Fax
(757) 594-3653
NPI assigned
Jul 26, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125.058686 IL
Internal Medicine Physician 207R00000X 294448 MA
Hospitalist Physician 208M00000X 0101260450 VA Primary

Addresses

Primary practice location

500 J Clyde Morris Blvd
Newport News, VA 23601-1929

Mailing address

PO Box 415348
Boston, MA 02241-5348
Phone (800) 225-8885

Other practice location 1

157 Union St
Marlborough, MA 01752-1228
Phone (508) 486-5678

Other practice location 2

119 Belmont St
Worcester, MA 01605-2903
Phone (508) 334-8515

Other practice location 3

55 Lake Ave N
Worcester, MA 01655-0002
Phone (508) 334-8515

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, MA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160914000324 VA Practitioner - Internal Medicine 3971731670 Reassigns benefits to 2 organizations
I20230105002576 MA Practitioner - Internal MedicinePractitioner - Hospitalist 3971731670 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125.058686ILMDInternal Medicine Physician
294448MAMDInternal Medicine Physician
0101260450VAMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Intensivist Services PC Internal Medicine CurrentSince Oct 1, 2019 Accepting new patients
Umass Memorial Medical Group, Inc. CurrentSince Nov 27, 2022 Accepting new patients
Vibra Physicians LLC Hospitalist CurrentSince Jun 19, 2019 Accepting new patients
Marlborough Hospitalist Group, PLLC Hospitalist CurrentSince Sep 20, 2023 Accepting new patients
Umass Memorial Medical Group Inc Internal Medicine CurrentSince Nov 27, 2022 Accepting new patients
Mass General Brigham Medical Group Western Massachusetts Inc Internal Medicine CurrentSince Jan 23, 2023 Accepting new patients

Locations

5 E River Park Pl E
Ste 460
Fresno, CA 93720

157 Union St
Marlborough, MA 01752
Phone (508) 481-5000

30 Locust St
Northampton, MA 01060
Phone (413) 582-2000

100 South St
Southbridge, MA 01550
Phone (508) 764-8012

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

119 Belmont St
Worcester, MA 01605
Phone (508) 334-6345

1401 Johnston Willis Dr
North Chesterfield, VA 23235
Phone (804) 327-4046

7101 Jahnke Rd
Richmond, VA 23225
Phone (804) 323-1088

1602 Skipwith Rd
Richmond, VA 23229
Phone (804) 289-4500

2220 Edward Holland Dr
Richmond, VA 23230
Phone (804) 678-7000

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1280102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671062400000",
    "number": "1962715425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415348",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415348",
            "telephone_number": "800-225-8885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 J CLYDE MORRIS BLVD",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236011929",
            "telephone_number": "757-594-3580",
            "fax_number": "757-594-3653"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "157 Union St",
            "address_purpose": "LOCATION",
            "city": "Marlborough",
            "state": "MA",
            "postal_code": "017521228",
            "country_code": "US",
            "telephone_number": "508-486-5678",
            "fax_number": "508-486-5677",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "119 Belmont St",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "016052903",
            "country_code": "US",
            "telephone_number": "508-334-8515",
            "fax_number": "508-334-6490",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "55 Lake Ave N",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "016550002",
            "country_code": "US",
            "telephone_number": "508-334-8515",
            "fax_number": "508-334-6490",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOLLAHALLI SHIVARAMAIAH",
        "first_name": "NAGESH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-26",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125.058686",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "294448",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "VA",
            "license": "0101260450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport News, VA

Sources for this page

Verify at the official NPI Registry.