Prajwal Basanna Keranalli, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

1201 S Grand Blvd
Saint Louis, MO 63104-1016

Phone

(314) 617-3749

NPI assigned

Apr 14, 2023

Last updated

Apr 24, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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 MO

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1681430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682294400000",
    "number": "1043906894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 SWEET CHERRY WAY",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "630402146",
            "telephone_number": "301-728-9565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 S GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041016",
            "telephone_number": "314-617-3749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERANALLI",
        "first_name": "PRAJWAL",
        "middle_name": "BASANNA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-14",
        "last_updated": "2023-04-24",
        "certification_date": "2023-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Nmi Kepler, ACNP
• Janice M Keplinger, R.N.
• Suzanne Marie Keppel Engel, CCC-SLP/L
• Paul Kepper, MD
• Carol Ann Keppler, R.N.
• Brooke Blythe Kerbel, MA, LPC
• Paul William Kerby, MD
• Anne Marie Kerchberger, MD, M. ENG.
• Andy Kerckhoff, PLPC
• Jessica A Kerckhoff, AUD

• Student in an Organized Health Care Education/Training Program in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Student in an Organized Health Care Education/Training Program in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2023; 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.

Verify at the official NPI Registry.