Active NPI
Aravind Buddula, DMD
- Periodontics
- Redmond, WA
National Provider Identifier
1023215902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DE 60121878
- Practice address
- 15640 Redmond Way
Redmond, WA 98052-3831 - Phone
- (425) 881-5533
- NPI assigned
- Jul 2, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DE 60121878 | WA | Primary |
Addresses
Primary practice location
15640 Redmond Way
Redmond, WA 98052-3831
Mailing address
15640 Redmond Way
Redmond, WA 98052-3831
Phone (425) 881-5533
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 347453000 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170117002326 | WA | Order and Referring Only - Other (Physician) | 6800981564 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE 60121878 | WA | MD | Periodontist |
Networks
- WA PPO C-SNP
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183334400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279670400000",
"number": "1023215902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15640 REDMOND WAY",
"city": "REDMOND",
"state": "WA",
"postal_code": "980523831",
"telephone_number": "425-881-5533"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15640 REDMOND WAY",
"city": "REDMOND",
"state": "WA",
"postal_code": "980523831",
"telephone_number": "425-881-5533"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUDDULA",
"first_name": "ARAVIND",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-02",
"last_updated": "2010-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "WA",
"license": "DE 60121878",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "347453000",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Redmond, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.