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PRANAV BOLLAVARAM
NPI 1629658133
Student in an Organized Health Care Education/Training Program in Columbus, OH

Active since April 09, 2021PECOS Enrolled
395 W 12TH AVE, COLUMBUS, OH 43210(614) 685-4411 Get Directions Write a Review

NPPES record last updated: August 8, 2022. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Aug 8, 2022, Apr 9, 2021 (2 updates tracked since 2021).

About Pranav Bollavaram NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PRANAV BOLLAVARAM (NPI 1629658133) is an individual student in an organized health care education/training program in Columbus, Ohio and active in the NPI registry since April 2021. He is enrolled in Medicare PECOS and is a graduate of Northeastern Ohio University College Of Medicine (2021).

NPPES Registry Identity

NPI1629658133
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NamePRANAV BOLLAVARAM
Location Address395 W 12TH AVEColumbus, OH 43210-1267
Mailing Address395 W 12th AveColumbus, OH 43210-1267
Phone(614) 685-4411
Sole ProprietorYes
Medical School CMSNortheastern Ohio University College Of MedicineGraduated 2021
Enumeration DateApril 9, 2021
Last NPPES UpdateAugust 8, 20222 updates tracked since enumeration
NPPES CertifiedAugust 8, 2022
✔ NPI 1629658133 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
395 W 12TH AVE, Columbus, OH 43210
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Pranav Bollavaram is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3173921756
PECOS Enrollment IDI20260623000227
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Pranav Bollavaram reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

North Shore - Lij Medical PC
494 mi
Internal Medicine
270-05 76TH AVE
New Hyde Park, NY 11040
  • Reassigned Medicare billing, New York enrollment
  • 9,353 clinicians in this Medicare group
NPI 1790043479 (516) 465-8089

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SHACHI SRIVATSA
Student in an Organized Health Care Education/Training Program
395 W 12TH AVE
COLUMBUS, OH 43210
Franklin County (614) 293-8704
KELVIN LIM-SUM CHAN MD
Radiology (Vascular & Interventional Radiology)
395 W 12TH AVE
COLUMBUS, OH 43210
Franklin County (614) 293-8315
MELISSA RAQUEL MAGYER MD
Radiology (Diagnostic Radiology)
395 W 12TH AVE
COLUMBUS, OH 43210
Franklin County (614) 293-8315
DR. SCOTT S LENOBEL M.D.
Radiology (Diagnostic Radiology)
395 W 12TH AVE
COLUMBUS, OH 43210
Franklin County (614) 293-8315
ALISON AUGSBURGER WHALEN
Student in an Organized Health Care Education/Training Program
395 W 12TH AVE
COLUMBUS, OH 43210
Franklin County (614) 293-8000
DR. MICHAEL FADELL M.D.
Radiology (Diagnostic Radiology)
395 W 12TH AVE
COLUMBUS, OH 43210
Franklin County (614) 293-8299
JOSHUA KARSTEN AALBERG DO
Radiology (Diagnostic Radiology)
395 W 12TH AVE
COLUMBUS, OH 43210
Franklin County (614) 293-8315
MARISSA GUO MD
Surgery
395 W 12TH AVE
COLUMBUS, OH 43210
Franklin County (609) 578-7122

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pranav Bollavaram's NPI number?

The NPI number for Pranav Bollavaram is 1629658133. It was assigned to this individual provider in the NPPES registry on April 9, 2021.

Where is Pranav Bollavaram located?

Pranav Bollavaram practices at 395 W 12th Ave, Columbus, OH 43210. The listed phone number is (614) 685-4411.

What is Pranav Bollavaram's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Pranav Bollavaram enrolled in Medicare?

Yes. Pranav Bollavaram is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Pranav Bollavaram's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Pranav Bollavaram reassigns Medicare benefits to North Shore - Lij Medical PC (New Hyde Park, NY). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Pranav Bollavaram's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Pranav Bollavaram was last updated on August 8, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.