Shiva Gundavaram, PHYSICAL THERAPIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

007938 Issued in CT

Practice address

3180 Main St Ste 303
Bridgeport, CT 06606-4237

Phone

(203) 373-1593

NPI assigned

Mar 15, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Core Physical Therapy and Sports Medicine PCGroup PAC ID 6204105364, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Core Physical Therapy & Sports Medicine PC

  dba Core Medical Group

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Bridgeport, CT
  • NPI 1609014893
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1394841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394841600000",
    "number": "1992121883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3180 MAIN ST STE 303",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066064237",
            "telephone_number": "203-373-1593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3180 MAIN ST STE 303",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066064237",
            "telephone_number": "203-373-1593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUNDAVARAM",
        "first_name": "SHIVA",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-03-15",
        "last_updated": "2014-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "007938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Guerrier, MSW,BSW
• Ian Fernando Guillen Alvarez, MD
• Alberto Rafael Guinazu, MD
• Alyssa Guirguis, PHARMD
• Samantha Guleserian, PA-C
• Steven Guon, MD
• Archana Gupta, DDS
• Nizi Gupta
• Shruti Gupta, MD
• Tessa Guralnick, DPT

• Physical Therapist in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Physical Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.