Individual provider Active NPI

Sasikanth Nagisetty Ravi, DO

  • Internal Medicine Physician
  • Glendale, AZ
National Provider Identifier
1992334163
Registry record updated Jul 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
R3455 Issued in AZ
Practice address
18701 N 67TH Ave
Glendale, AZ 85308-7100
Phone
(623) 561-1000
NPI assigned
Apr 8, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 22, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X R3455 AZ Primary

Addresses

Primary practice location

18701 N 67TH Ave
Glendale, AZ 85308-7100

Mailing address

5021 N 81St Ave
Glendale, AZ 85303-5505
Phone (480) 489-0669

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20240507002127 NJ Practitioner - Internal Medicine 5799126892 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Arizona College of Osteopathic Medicine Mid Western University, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint Peters University HospitalGroup PAC ID 9931012382, 158 clinicians

Practice addresses (Care Compare)

254 Easton Ave
New Brunswick, NJ 08901-1766
Phone (732) 745-8600

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R3455AZMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Peter'S University Hospital CurrentSince Apr 3, 2024 Accepting new patients
Saint Peter'S University Hospital CurrentSince Apr 3, 2024 Accepting new patients

Locations

254 Easton Ave
Ofc
New Brunswick, NJ 08901
Phone (732) 745-6674

254 Easton Ave
New Brunswick, NJ 08901
Phone (732) 565-5453

123 How Ln
New Brunswick, NJ 08901
Phone (732) 448-1000

Interoperability endpoints

  • Direct secure messaging: sasikanth.ravi.1@8568.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/8568/brand/1/csg/1/fhir/r4

Organizations & group practices 2

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": "1586304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658448000000",
    "number": "1992334163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5021 N 81ST AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853035505",
            "telephone_number": "480-489-0669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18701 N 67TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853087100",
            "telephone_number": "623-561-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAVI",
        "first_name": "SASIKANTH",
        "middle_name": "NAGISETTY",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-08",
        "last_updated": "2022-07-22",
        "certification_date": "2022-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "R3455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.