Mounika Addula

Key facts

NPI

1013569185

Entity type

Individual (NPI type 1)

Primary specialty

Internal Medicine Physician 207R00000X

License

ME158426 (FL)

Practice address

1190 NE 125TH St Ste 220
North Miami, FL 33161-5020

Phone

(305) 891-7500

Fax

(305) 985-6233

NPI assigned

Jul 9, 2019

Sex

Female

Sole proprietor

No

Organizations & group practices 3

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.

• Banner Primary Care Physicians Arizona LLC Primary Care Clinic/Center · Phoenix, AZ · NPI 1659640902
  Medicare reassignment Care Compare group NPD AZ
• Banner Primary Care Physicians Arizona LLC Primary Care Clinic/Center · Phoenix, AZ · NPI 1790306066
  NPD
• Banner Primary Care Physicians Arizona LLC Primary Care Clinic/Center · Phoenix, AZ · NPI 1417238908
  NPD (past)

Medicare Care Compare profile

Specialty

Internal Medicine

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Banner Primary Care Physicians Arizona LLC (236 clinicians)

Practice addresses (Care Compare)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

Practice roles (3 of 4)

Locations

Networks

• NM HMO C-SNP

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 15, 2022.

{
    "created_epoch": "1562630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660521600000",
    "number": "1013569185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1190 NE 125TH ST STE 220",
            "city": "NORTH MIAMI",
            "state": "FL",
            "postal_code": "331615020",
            "telephone_number": "305-891-7500",
            "fax_number": "305-985-6233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 NE 125TH ST STE 220",
            "city": "NORTH MIAMI",
            "state": "FL",
            "postal_code": "331615020",
            "telephone_number": "305-891-7500",
            "fax_number": "305-985-6233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADDULA",
        "first_name": "MOUNIKA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-09",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME158426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in North Miami, FL · Internal Medicine Physician in Florida